Unusual Foreign Body in the Maxillary Antrum (A Bunch of Hair) VINEET SINHA & A. K. SINHA

A case o f u n u s u a l fore ign body in the m a x i l l a r y a n t u m is reported for i ts rarity .

Case Report

VSS, a 30 years old Hindu Male, belonging to district Bhojpur, Bihar, presented in the ENT dept. of Patna Medical College Hospital with the complaint of a pus discharging sinus on the right cheek with a history of gunshot injury a month back. He also had swelling over the right cheek and foul smelling discharge from the nose. He had a healed wound on the left side of the lower abdomen wkich was Mso due to gunshot wound at the same time and was treated in the department of General Surgery and multiple pellets were removed.

Past history/family & personal history did not reveal anything of particular importance.

The patient's general health was quite fair. Systemic examination did not reveal any abnormali ty except for the scar mark on the the lower abdomen on the left side which was due to surgical interven- tion. There was no evidence of any visceral rupture due to gunshot.

Local E x a m i n a t i o n

A wound of small dimension 1 cm × 1 cm was present on the right side of face just below the malax prominence. It was a sinus which was confirmed by probing and pressure over the surrounding area squeezed foul smelling pus from it. The lower part of the wound was hard and indurated. There was generalised tender swel- ling over the right cheek. The left side of the face was ahnost normal.

Vineet Sinha, P.G. Student & A. K. Sit, ha, Asstt. Professor, Department of E.N.T. Patna Medical College Hospital, Patna.

Request for Reprint : Dr. A. K. Sinha, Asstt. Professor, Deptt. of E.N.T. Patna Medical College Hospital, Patna.

There was no defect in the bony orbit.

Examination of the nose revealed foul smelling pus in the middle meatus of the right side. Left side was normal. Posterior rhinoscopy did not reveal any abnormality. Nasal patency test was normal on both sides.

Examination of the throat did not reveal any abnormali ty.

Ear examination revealed normal tympanic membrane on both sides and hearing tests were normal. The vestibular function tests were also normal. Speech was no rmal.

Investigation of the blood showed H b % to be 98%, total count of WBC was 6,350/cu m.m. Differen- tial count of WBC showed Poly- morphs 68%, Lymphocytes 26.8%, Eosinopoils 3.2% and Moonocytes 2.0%. Bleeding time was 46 aeconds and dot t ing time was 3 minutes 18 seconds.

embedded. These pellets (Fig. 4) were removed. The whole b u n c h of tlair was cleared from the a n t r u m meticulously and an intranasal an- trostomy fashioned througk the in- ferior meatus. The ant rum was

Routine examination of urine was normal.

Fig.1. X-Ray of the Maxillary Sinuses showing metallic pellets.

X Ray of the maxillary sinuses showed (Fig. 1) 5 radioopaque shadows of metallic pellets, 3 on the right side and 2 on the left side. The size of the pellets were roughly equal to that of a pea. The location was in the maxillary ant rum on both sides (Fig. 2) and the soft tissues around it. The nasal septum was in the midline and other para- nasal sinuses were normal. Bony orbit was intact.

Operat ive procedure

The maxillary antrum was opened through the sublabial route used for classical Caldwell-Luc operation. On opening the antrum it was found to be full of hairs (Fig. 3). It was taken out by Luc's forceps and scoop. The whole antrum was full of foul smell.ing bunch of hairs in which two pellets of 'pea size' were

Fig.2. The location of pellets in the Maxi- llary antrum on both sides.

64 Indian Journal of Otolaryngology, Volume 41, No. 2, June, 1989

Unusual Foreign Body in the Maxilliary Antrum (A bunch of hair)--Sinha & Sinha

Fig.3. Showing the bunch of hairs removed from the maxillary sinus

packed with gauze impregnated with antibiotic ointment.

The external wound was incised a little to find the third pellet just below the opening of the sinus. The whole t ract was removed. The sinus was communica t ing with the maxil- lary an t rum. I t was meticulously cleaned by a scoop and the incision closed with three interrupted sutures.

The pat ient was kept on parenteral antibiotics and an t i f l ammatory drugs for 7 days. T h e pack was removed

. , . > - 2 . "

',; ........ ":9' % ?;%~" 4 ~,> - "-",%':*°~'~,,:

Fig.4. Showing the pellets after removal

on the 3rd pos t -opera t lve day. Recovery was smooth and unevent- ful.

C o m m e n t s

The finding of hairs in the maxil- lary an t rum has not been repor ted anywhere. I t is very unusual to find hair in the ant rum. I n this case it can be explained that tim presence of hair in the maxi l lary a n t r u m was due to lodging of the beard of the

p a t i e n t due to the impac t of the gunshot which was fired f rom close range. T h e gunshot injury healed and the ha i r remained inside the an t rum.

Some of the fibres showed charac- teristics ment ioned in 'A ' while some showed characterist ics men- tioned in 'B'. Forensic Exper t ' s opinion regarding the hairs removed from maxil lary a n t r u m is :

(A) Diameter of the shaft---400 Microns, Medul la - - About 3/4th of cortex. Heav i ly p igmented. Cuticle coarse and protruding. Opinion - - H a i r of animal origin.

(B) Diameter of the shaft - - 60 Microns. M e d u l l a - I /4 th of the shaft, Sparsely pigmented. Cuticle - - Flat tened Scales. Opirfion - - H a i r o f h u m a n origin.

F i n a l O p i n i o n :

Sample of hair sent appears to be of mixed origin i.e., bo th H u m a n and Animal.

This can be explained that the pat ient was bearded at the t ime of gun-shot wound and his beard and the horse's hair (which is used to pack the catridge) was lodged inside the maxi l lary ant rum.)

Indian Journal of Otolaryngology, Volume 41, No. 2, June, 1989 65