OtoRhinoLaryngology Portal

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Nasal Foreign Body: Unilateral Discharge

 

Unilateral nasal discharge in a child raise the suspicion of foreign body impaction.  Organic foreign body induces more local reaction and may present with foul-smelling discharge with or without blood-stains.

 

 

             Video of Left Nasal Cavity Foreign Body Removal

 

A clearly visible left nasal cavity foreign body (blue bead).

 

 

             Video of Right Nasal Cavity Foreign Body

 

             Video of Left Nasal Cavity Foreign Body

Suitable Instruments for Removal of Nasal Foreign Bodies

 From top: Jobson-Horne probe, hook, and crocodile forceps.

 

 Quire foreign body lever.

Forein Body In The Ear Canal

Multiple foreign bodies in both ear canals consisting of color pencil tips.

 Right ear.

 Left ear.

 

Removal of the foreign bodies was performed under general anaesthesia as the child was uncooperative.  Both eardrums were found intact.

Removal of Round-Shaped Foreign Body In The Ear Canal

Prerequisites:

 

1. The child must be cooperative; if not general anaesthesia is required.

2. There must be a space to allow safe introduction of instrument (such as Jobson Horne probe) beyond the foreign body.

Examine the ear canal of the affected side after the foreign body removed to document the state of the eardrum and osseous meatus.  Please examine the contralateral ear as well to ensure it is normal and no foreign body there.

 

Watch video of toy pistol bullet removal @ YouTube.

Epistaxis: Chemical Cautery of Abnormal Vessels

Traumatic Lacerations of Lower Lip: Toilet & Suturing

 Before surgery.

 

After surgery. 

Traumatic Lacerations of Oral Cavity Structures

Endoscopic view prior to repair.

Endoscopic view after toilet & suturing perfotmed. 

Laceration involving left anterolateral surface of tongue following fall.  Toilet and suturing was performed by using Vicryl 5/0 absorbable sutures.

Jaw retractor which was used to maintained open mouth position during surgery.

Laceration involving left anterolateral surface of tongue following fall.  Toilet and suturing was performed by using Vicryl 5/0 absorbable sutures.

Jaw retractor which was used to maintained open mouth position during surgery.

Foreign Body In The Throat

 

 

 

 

 Fishbone impaction into left tonsillar tirssue in a 3 year old child.  Removal was performed under general anaesthesia as the child became un-cooperative with strong gag reflex when attempt at removal as an outpatient procedure.  Endoscopic-assisted removal using Negus forceps was done as depicted above.

Traumatic Lacerations of Skin

 

Traumatic laceration of right pinna with torn cartilage (arrow). 

 

 Deep glabella laceration reaching the bone!

 

Precise approximation by using absorbable sutures is preferred in children as removal of non-absorbable suture can be frightening to them.  Tissue adhesive glue is an alternative if the wound is small with clean edges.

Screamer's Nodules

 An established vocal fold nodules in a child resulting in hoarseness.

 

An incidental finding of vocal fold nodules (arrows) in a child undergoing endoscopic examination of pharynx under general anaesthesia for suspected foreign body impaction.  The arytenoid mucosa appeared inflamed and oedematous (+) suggestive of reflux laryngitis.  [PPW - posterior pharyngeal wall]

 

 

            Video of Screamer's Nodules

Endotracheal Intubation-Related Lesions

Post-intubation granuloma. (See Video)

 

Video of Tongues of Granulation Tissue in Early Post-Intubation Injury

 

Stages of Injury

I.Tongues of granulation tissue occur consistently at the vocal processes.

II.Ulcerated troughs occur in the acute phase.

III.Healed furrows occur in the chronic phase as a result of healing of the ulcerated troughs.

IV.Healed fibrous nodule (see Fig. 102-21) is a small, rounded, persistent, chronic scar.

 

 Grade III acquired subglottic stenosis.

Grade IV post-intubation subglottic stenosis with posterior glottic scar.


 

More Info

 

Suggested readings:

 

1.Benjamin B. Prolonged intubation injuries of the larynx:endoscopic diagnosis, classification, and treatment. Ann Otol Rhinol Laryngol Suppl. 1993 Apr:160:1-15.
2.Gold SM, Gerber ME, Shott SR, Myer CM III. Blunt laryngeal injury in children. Arch Otolaryngol Head Neck Surg 1997;123:83.

Posterior Glottic Web

Head Injury: Temporal Bone Fractures

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