foreignbodynose 1234567890-0987654321.pdf

f b nose

1. FOREIGN BODY NOSE

2. WHAT IS FOREIGN BODY?
•An object is considered a "foreign body" if the
object is in a location in the body where it does
not belong

3. •Commonly encountered in emergency department
•In children (2-4years)
•Seen in adults who are mentally retarder or psychiatric
illness
•Foreign body nose harborspotential for mortality if the
object is dislodged into airway

4. FREQUENTLY ENCOUNTERED FOREIGN
BODIES:
•Pebbles
•Slate pencils
•Beads
•marbles
•peas
•Beans
•nuts
•button batteries
•paper wads

5. TYPES OF FOREIGN BODY
•ANIMATE:
1.Maggot
2.Worms
INANIMATE:
1.Vegetable FB :paes,beans
2.Mineral FB : metal , plastic toys
3.Post surgical : swabs , packs
4.Sequestra: syphilis , neoplasms

6. BUTTON BATTERIES:
•result in severe destruction of the nasal
septum.
•These are composed of various types of heavy
metals: mercury, zinc, silver, nickel, cadmium,
and lithium. Liberation of these substances
causes various types of lesions depending on
the localisation,
•it causes intense local tissue reaction and
liquefaction necrosis.
•As a result they can causeseptal
perforations, synechiae, constriction, and
stenosisof the nasal cavity.

7. CONSEQUENCES:
Inert Foreign body
Infection and inflammation of
mucous membrane
Granulation tissue formation
and ulceration of mucosa
Necrosis of bone or cartilage
Vegetable foreign body
Absorb water and swell
evoke brisk inflammatory
response

8. SYMPTOMS:
•Unilateral fetid discharge:
mucopurulentor blood
stained
•u/l nasal obstruction
•Pain
•Nasal bleed
•Excoriation of nasal
vestibular skin

9. LOCAL EXAMINATION:
•Main diagnostic tool
•Object mostly found beneath
inferior turbinate or anterior
to middle turbinate
•Erythema,edema
•Bleeding ,fetid nasal discharge
•Visualize T.M for acute otitis
media
•Nuchalrigidity
•Assess for sinusitis

10. RHINOLITH
•Usually forms around the
nucleus of a small
exogenous FB, blood clot
,inspissatedsecretion by
slow deposition of
calcium and magnesium
salts

11. NASAL MYIASIS (MAGGOTS IN NOSE)
•Larval forms of flies (chrysomyia)
•Attracted by foul smelling discharge
(atropicrhinitis , syphilis , leprosy ,
infected wound)
•Patient presents with intense irritation ,
sneezing , lacrimation, headache
,epistaxis, foul smell
•Maggots can cause extensive damage to
nose , sinuses ,soft tissue of face ,palate
and eyeball
•Death can occur from meningitis

12. INVESTIGATIONS
•Nasal endoscopy
•X-ray may reveal
radiopaqueFB
•NCCT nose and PNS

13. DIFFERENTIAL DIAGNOSIS
•Neoplasm
•Unilateral sinusitis
•Unilateral choanalatresia

14. POSITIVE PRESSURE TECHNIQUE:
•Tell the kid that parent is going
to give them a kiss
•Instruct the parent to form a
good seal on mouth and then
blow into mouth while
occluding unaffected nostril
•It has a very low risk of baro-
trauma (<60mm hg ) , similar to
a sneeze

15. MANAGEMENT:
ANIMATE FOREIGN BODY (Maggots)
•Isolation and broad spectrum antibiotics and analgesics
•Good nourishment
•Tablet vitamins and iron
•Inj. Tetanus
•Manual removal of maggots after placing cotton pledgets
soaked in 25% chloroform and terpentineoil(4:1)
•Alkaline douchings
•Primary causative factor is taken care of

16. INANIMATE FB REMOVAL:
•Child is restrained in upright
position
•Add few drops of nasal
decongestant
•Proper suctioning to
visualise FB
•Curved hook is passed
beyond FB and gradually
drawn forward and removed
completely

17. USING FOGARTYCATHETER:
•Additional method
•Ensure that balloon is
intact
•Catheter is placed beyond
the foreign body
•Balloon is then inflated
•Catheter is withdrawn
through the anterior
narespulling the foreign
body

18. INDICATIONS FOR GENERAL
ANAESTHESIA
•Uncooperative and very apprehensive patients
•If troublesome bleeding is anticipated
•If the FB is posteriorlyplaced with a risk of pushing it
back in to nasopharynx
•If a foreign body is strongly suspected but cannot be seen
in anterior rhinoscopyand radiolucent

19. REMOVAL OF FB UNDER GENERAL
ANAESTHESIA:
•Patient is anaesthetised with cuffed ET tube
•Pharyngeal pack placed
•If FB is placed posteriorly, patient positioned in rose
position and mouth gag applied.
•Palate is generally retracted with a catheter which is
placed through unaffected nasal cavity
•FB is pushed from anterior naresin to the nasopharynx
and pick up with foreps

20. REMOVALOF RHINOLITH:
•Done under general anaesthesia
•It is removed in peacemeal
•If very large –it is removed by lateral rhinotomy