Unexpected Nasopharyngeal Foreign Body

Case Report

Unexpected nasopharyngeal foreign body

Sanjeev Gupta*, Surya Kanta Pradhan

Department of ENT e Head Neck Surgery, Apollo Hospitals, 251, Sainik School Road, Unit-15, Bhubaneswar 751005,

Orissa, India

a r t i c l e i n f o

Article history:

Received 28 September 2013

Accepted 5 November 2013

Available online 23 November 2013

Keywords:

Nasopharynx

Foreign body

Tooth brush

CT-scan

a b s t r a c t

Nasopharynx is a rare area to find a foreign body because of its location and structure. We

are reporting a case of impacted foreign body in nasopharynx in a 13 months old child.

Copyright ª 2013, Indraprastha Medical Corporation Ltd. All rights reserved.

1. Introduction

Foreign bodies in aerodigestive tract are common entity but in

nasopharynx it’s very rare to find an impacted foreign body

(FB). The anatomical structure of nasopharynx prevents any

lodgement of foreign body. It is capacious and having naso-

pharyngeal sphincter preventing regurgitation of FB from

oropharynx. Through nasal cavity FB cannot travel to naso-

pharynx as the former is narrower. Most of the FB gets

impacted as a result of forceful emesis, coughing, penetrating

trauma or manoeuvre for removal of FB from oropharynx.

2. Case report

A 13 months old male child came to our OPD with complaints

ofmild difficulty in breathing, excessive salivation and nausea

for one day. He was having history of playing with a tooth

brush and he fell down on his face while the brush was inside

the oral cavity. The bristle part of the brush remained inside

and got lost while the remaining part came out. After few

hours he developed the above symptoms and they decided to

take medical help. The local medical practitioner advised for

X-ray neck, chest and abdomen. The FB was not visualised in

the radiograph and he was unable to localise it. After that he

was referred to amedical college where he was examined and

suspected to have FB in bronchus or trachea and referred to us

for removal by bronchoscopy.1

On examination the child was irritable. The vitals were

maintained. Mild respiratory distress was present but with

bilateral normal air entry and no stridor. Ear, nose and throat

were normal on examination. Nasal endoscopy or nasophar-

yngoscopy could not be done as the child was very small and

irritable. We advised for CT Neck with reconstruction sus-

pecting a radiolucent FB in aerodigestive tract. To our surprise

* Corresponding author. Tel.: þ91 8093060206 (mobile).E-mail addresses: drsanjeev_g@apollohospitals.com, sanjeevapollo@yahoo.com (S. Gupta).

Available online at www.sciencedirect.com

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the FB (broken tooth brush) was found to be impacted in the

nasopharynx (Figs. 1 and 2).

Patient was taken for removal of FB under GA. He was

placed in Rose’s position and BoyleseDavis mouth gag

applied. The nasopharynx was approached trans-orally. The

soft palate was retracted upwards by the anterior pillar

retractor. The lower part of the FBwas visualised. It was firmly

stuck in the nasopharynx. It was gently manipulated using a

blunt dissector and the FB was brought into the oropharynx

and then removed without any trauma to nasopharynx. The

nasopharynx was examined using 70 � telescope. As it was a

large FB we did not use nasal endoscope for accessing the FB.

The patient was discharged on the same evening without any

intra-operative or postoperative complications (Fig. 3).

3. Discussion

Foreign body nasopharynx in such a small baby is rare.Most of

the patients present as nasal obstruction, nasal discharge

with or without any breathing or swallowing difficulty but

some remain asymptomatic for a longer period and present

mimicking adenoid hypertrophy and sinusitis.2,3 Most of the

patients can be diagnosed using flexible nasopharyngoscope

or nasal endoscopes.4 In case of a lost FB, radiography should

include X-ray of nasopharynx along with neck, chest and

abdomen.5 Computed tomography and magnetic resonance

imaging could be helpful in selective cases with radiolucent

foreign bodies.

Foreign body in nasopharynx should be kept in mind as a

differential diagnosis in case of a lost FB which may cause

fatal complications if not removed timely. It may dislodge

from the site during coughing, sneezing or manual removal

causing obstruction to larynx and respiratory arrest.

Conflicts of interest

All authors have none to declare.

r e f e r e n c e s

1. Kumar J, Gupta A. Nasopharyngeal foreign body in a youngchild. Indian J Otorhinolaryngol. 2011;63(3):285e286.

Fig. 1 e CT-scan showing impacted brush in the

nasopharynx.

Fig. 2 e 3D reconstruction of CT-scan showing brush below

base of skull.

Fig. 3 e Brush head after removal.

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2. Oysu C, Yilmaz HB, Sahin AA, Kulekci M. Marble impaction inthe nasopharynx following oral ingestion. Eur ArchOtorhinolaryngol. 2003;260:522e523.

3. Eghtedari F. Long lasting nasopharyngeal foreign body.Otolaryngol Head Neck Surg. 2003;129(3):293e294.

4. Singh RK, Varshney S, Bist SS, Gupta N. A rare nasopharyngealforeign body. Online J Health Allied Sci. 2008;7(1):10.

5. Parker AJ, Bingham BJ, Osborne JE. The swallowed foreignbody. Is it in the nasopharynx? Postgrad Med J. 1988;64:201e203.

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