OtoRhinoLaryngology Portal

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Foreign Body: Round Bead

Round bead in right nasal cavity (above) and after its removal (below).  Jobson-Horne probe is shown adjacent to the  removed foreign body.

 Foreign body in left nasal cavity (blue colour) which was removed by using similar tool as shown above.

Foreign Body: Toys Part

Plastic foreign body (X) in left nasal cavity.  It was removed by using a crocodile forceps.  (S - nasal septum, IT - inferior turbinate)

 

 

Impacted Foreign with Granulations Formation

 Endoscopic view of left nasal cavity with impacted foreign body in place.  (FB - foreign body, S - nasal septum, IT - inferior turbinate)

Endoscopic view of left nasal cavity after the foreign body removed.  Multiple granulations seen (arrows) due to prolonged mucosal irritations by the foreign body with secondary infection.  (S - nasal septum, IT - inferior turbinate)

Foul  Smell Nasal Discharge In A Child

 

 

This 3 year child was noted to have foul-smell right-sided nasal discharge and redness of skin above her lip on the same side.  Endoscopic examination under general anaesthesia with careful suctioning showed crumb-like foreign body which was removed complete.  Brisk mucosal bleeds occured due to secondary infection of the mucosal lining adjacent to the stuck foreign body.  The material proved to be a piece of cushion sofa!.  The dictum proven true - unilateral nasal dischage in a child is due to impacted foreign body until proven otherwise!

Foreign Body: Chemical-Induced Caustic Injury

Button-type battery foreign body (arrow) in right nasal cavity which had caused caustic burns to inferior turbinate and septal mucosa upon leaking of its chemical contents.  [IT - inferior turbinate, S - nasal septum]

 

Further reading:

1. Ettyreddy AR, Georg MW, Chi DH, Gaines BA, Simons JP. Button battery injuries in the paediatric aerodigestive tract. Ear Nose Throat J. 2015 Dec;94(12):486-93.

2. Lin VY, Daniel SJ, Papsin BC. Button batteries in the ear, nose and upper aerodigestive tract. Int J Pediatr Otorhinolaryngol. 2004 Apr;68(4):473-9.

Rhinolith

This figure shows a calcareus material in right nasal cavity which had developed insiduously.  Probing revealed a rough and hard substance aliken to coral.  In the majority its presence is asymtomatic and found incidentally upon nasal assessment for other otolaryngologic presentation.  Patient who has symptom may present with blood-stained nasal discharge, slow and progressive unilateral nasal obstruction and unexplained rhinorrhea.

Stone fragments of the rhinolith with the foreign body (circle) acted as a nidus of its formation.

 

Watch video of rhinolith @ YouTube

Video 1             Video 2

 

 

Instruments for Foreign Body Removal

1. Quire's forceps.

2. Sharp-angled hook.

3. Ring curette.

4. Suction tip.

 

Not shown: Crocodile forceps.

 

Depending on foreign body seen or suspected, instruments shown above can be used alone or in combination as justified to remove foreign body from nasal cavity.

 A foreign body removed from right nasal cavity shown together with the instrument used to rake it out.

 Crocodile forceps being used for removal of this tube-like foreign body.

Unilateral Epistaxis: Retrieval of A Leech From The Left Nasal Cavity

Live Leech In The Nose

Cerebrospinal Fluid (CSF) Rhinorrhea

 

Watch video of CSF rhinorrhea @ YouTube

Nasal Bone/Septal Fractures

                   A                                     B                                      C

 

Figures showing external appearance of mid-face in a patient who had blunt injury resulting in nasal bones and septum fractures.  Nasal endoscopy showed septal mucosa bruise superiorly and severe deviation resulting in near complete right nasal obstruction due to fracture.  Black interrupted line indicate deviation of nose alignment as compared to normal (red interrupted line). A - front view, B - superior view, C - inferior view. 

CT-scan showing the fractured septum on coronal and axial view respectively.

Nasal Bones Fracture Reduction Forceps

External Nasal Splint

An example of external nasal splint: above - anterior surface and below - its posterior suface with adhesive pads attached. This foldable aluminium splint is then shaped according to the patient's nose shape and applied with the adhesive part in contact with the skin.  This splint helps to stabilize the fractured segments while allowing healing to take place. The correct size is chosen to conform the patient's nose length and width. 

Removal of Internal Nasal Splints

Telangiectasias

Multiple telagiectasias in Osler-Weber-Rendu syndrome.

 

Read more on Osler-Weber-Rendu Disease @ e-medicine.medscape 

 

Watch video of Osler Weber Rendu disease @ YouTube

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