A 45 y.o. female was picking her nose with a bobby pin when it "opened" and she was unable to remove it.
she was seen at an OSH where they were also unable to remove it and she was sent to Wash U.
A CT was done shown below
it iis wedged against the nasal bone. How would you remove it?
Nasal foreign bodies are commonly seen; often in the pediatric population. They cause risk for bleeding, infection and aspiration. They are usually found near the floor of the inferior turbinate or anterior to the middle turbinate. Several types of inanimate foreign bodies cause unique problems: those that absorb water can become a rhinolith as they turn into hard objects from accumulation of minerals and batteries which cause liquefactive necrosis. Paired magnets create a current which also produces liquefaction necrosis.
In children the problem is often finding out that a foreign body has been inserted. Unilateral nasal discharge or bleeding can be a clue. Sneezing and headaches may also be present.
In addition to inanimate objects in the nose, animate objects are also found. Live foreign bodies present a unique problem. Maggots, the larval stage of the blow fly, can burrow into living tissue in the nose. A recent case was reported in Florida. (yes, a Florida man was seen for a nosebleed and 150 maggots were removed from his nasal cavity and sinuses) Ascaris will also be found occasionally in the nose after being regurgitated or coughed up.
This is what ENT saw in the case of the Florida man with a nosebleed. He was immune suppressed and had been working around dead fish covered with flies. He had nasal myiasis, an infestation of larvae in the nose.
In the case of our patient ENT numbed the nasal cavity with lidocaine and sprayed it with afrin. A Blakesley forceps was used to grasp the upper part of the bobby pin and move it posteriorly away from the nasal bone. It was then pulled inferiorly to match the two parts of the pin together and remove it through the front of the nose. She was discharged from the ED.
The Blakesley forceps has a sturdy tip and can grasp foreign bodies.
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