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Magnetic removal of a nasal foreign body
International Journal of Pediatric Otorhinolaryngology 62 (2002) 165– 167 www.elsevier.com/locate/ijporl
Case report
Magnetic removal of a nasal foreign body Susan A. Douglas, Showkat Mirza *, Francis W. Stafford Head & Neck Surgery, Department of Otolaryngology, Freeman Hospital, Newcastle-upon Tyne, UK Received 3 August 2001; accepted 4 October 2001
Abstract We describe a case of metallic nasal foreign body removal from a child with the aid of a permanent magnet. This is the first documented case of such a technique as far as we are aware. Magnets may prove invaluable in the removal of metallic nasal foreign bodies particularly in children and avoid the need for a general anaesthetic. A brief review of the use of magnets to remove foreign bodies is included. © 2002 Elsevier Science Ireland Ltd. All rights reserved. Keywords: Foreign body; Nasal; Magnet
1. Introduction The removal of nasal foreign bodies in young children can be a traumatic experience for the patient and parents, as well as the physician involved. Young children are often resistant to the idea of sharp-looking objects, such as the forceps and hooks used by otolaryngologists, being introduced into the nose. Devices that can safely hasten and ease the process of removal may prove invaluable for patient and physician comfort. Magnets have been used to remove metallic foreign bodies from various parts of the body including the eye [1,2], frontal sinus [3], upper * Corresponding author. Present address: 38 The Ropery, St. Peters Basin, Newcastle-upon Tyne NE6 1TY, UK. Tel.: +44-191-275-9127. E-mail address: [email protected] (S. Mirza).
digestive tract [4,5], tracheobronchial tree [6,7] and external auditory meatus [8]. This is, as far as we are aware, the first report of the removal of a metallic nasal foreign body using a permanent magnet. 2. Case history A 1-year-old child presented with a short history of a right-sided metallic ball bearing nasal foreign body. The casualty officer was unable to remove the object and the child was referred to our Department of Otolaryngology. On arrival, the child was asleep. Examination of the right nasal cavity revealed the foreign body lodged between the inferior turbinate and nasal septum. A household magnet that was at hand was applied to the nostril in an attempt to remove the object but the ball bearing was too lodged in
0165-5876/02/$ - see front matter © 2002 Elsevier Science Ireland Ltd. All rights reserved. PII: S 0 1 6 5 - 5 8 7 6 ( 0 1 ) 0 0 6 0 9 - 7
166
S.A. Douglas et al. / Int. J. Pediatr. Otorhinolaryngol. 62 (2002) 165–167
place. A blunt hook loosened the object, but at this point the child awoke and became uncooperative. The magnet was again applied to the nostril and the foreign body was briskly removed with no nasal trauma (Fig. 1).
3. Discussion Magnets have been successful in the removal of foreign bodies from various anatomic locations. Volle et al. [4] and McDermott et al. [5] described the removal of disc batteries from the oesophagus and stomach in children, by the use of an orogastric magnet under fluoroscopic control. The orogastric magnet consisted of a magnet attached to the end of a long silastic tube, similar to a nasogastric tube. They found the technique to be simple, safe, well tolerated and effective, avoiding the need for general anaesthesia and surgery. Mayr et al. [6] described the use of a wire with a magnetic tip fitting into the working channel of a rigid bronchoscope in order to remove a ferromagnetic foreign body from the tracheobronchial tree of a child. In this instance a magnet may prove invaluable in the extraction of foreign bodies from the relatively small diameter paediatric airway. Ophthalmologists regularly use electromagnets [2] as well as small rare-earth magnets on the end of a thin non-magnetic introducer [1] to remove intraocular ferromagnetic foreign bodies. Landry and Edmuson [8] described the removal of a watch battery from an ear canal using a magnetized screwdriver. The removal of iatrogenic metallic foreign bodies with a magnet has been described including a broken blade during a hip arthroplasty [9] and a broken fragment of a forceps during a transbronchial lung biopsy [7]. Calhoun et al. [3] described the removal of an air gun pellet from the frontal sinus with the use of an ophthalmic foreign body electromagnet. The electromagnet had various different tip end shapes. Using an electromagnet with a curved 40-mm long tip and a flattened 2-mm wide end, allowed its insertion through a frontal sinus trephination, enabling the extraction of the pellet. A number of cases of removing magnetic earrings stuck together across the nasal septum have
recently been reported [10–14]. These patients used bilateral nasal magnetic earrings to mimic nasal piercing. Unfortunately, the two intranasal magnets became attracted to each other across the nasal septum. Garfinkle [10] described removing one magnet with a Hartmann forceps and then on reinserting the forceps, the second magnet jumped out of the nose, attracted to the metallic forceps. Pitetti et al. [11] found each magnet became attracted to a limb of a nasal bayonet forceps and both magnets were removed simultaneously by inserting one limb of the forceps into each nasal cavity. Ward and Selvadurai [12] polarized a wax hook to remove the magnets. At times a general anaesthetic may be necessary to allow removal [13]. Lancaster et al. [14] described a case where the attempted removal of the magnets was abandoned due to discomfort. Removal under a general anaesthetic was delayed by 36 h, resulting in pressure necrosis and a septal perforation. Our case represents the first description of the removal of a nasal foreign body with a permanent magnet. The magnet enabled the swift atraumatic removal of the metallic foreign body and avoided the need for a general anaesthetic. The magnet used was a 10-mm diameter neodymium magnet, at the end of a handle (Fig. 1). We have now acquired a number of magnets, including rod magnets of 3, 4 and 5 mm diameter. These are of a shape that would allow their insertion into the nasal cavity or even the external auditory meatus.
Fig. 1. A household magnet used to remove a metal ball bearing nasal foreign body.
S.A. Douglas et al. / Int. J. Pediatr. Otorhinolaryngol. 62 (2002) 165–167
167
4. Conclusion We recommend that Departments of Otolaryngology possess magnets to aid in the rapid and atraumatic removal of metallic nasal foreign bodies.
References
Fig. 2. The Alcomax III rod magnets (3, 4 and 5-mm diameters× 30-mm length) and a neodymium iron boron magnet (25-mm diameter × 7-mm axis).
In addition, we have the more powerful 25-mm neodymium iron–boron magnet, though its size precludes insertion into the nasal cavity (Fig. 2). This array of magnets may aid the removal of metallic nasal foreign bodies as well as foreign bodies in the ear canal. In addition, they may assist in the removal of the aforementioned metallic earring foreign bodies and avoid complications. It has been well documented that intranasal disc batteries, such as those found in watches and calculators, can result in tissue necrosis, septal perforation, scarring and saddle deformity [15,16]. In order to prevent these complications, the prompt removal of these foreign bodies from the nose is essential and to that end, magnets may prove invaluable. In circumstances, where the foreign body has been in place for a while, the mucosa may become friable with visualization of the foreign body proving difficult. A magnet may be particularly useful in this situation. The electromagnet has a stronger magnetic field than a permanent one and may be worth trying when a permanent magnet is unsuccessful in foreign body retrieval. Many ophthalmology departments contain an electromagnet, but these tend to be quite cumbersome and would need to be housed on the same site as the ENT department to be of practical use.
[1] G.W. Crock, P. Janakiraman, P. Reddy, Intraocular magnet of Parel, Br. J. Ophthalmol. 70 (1986) 879 – 885. [2] A.R. Irvine, Old and new techniques combined in the management of intraocular foreign bodies, Ann. Ophthalmol. 13 (1981) 41 – 47. [3] K.H. Calhoun, B.R. Peters, C.M. Steinberg, F.B. Quinn, Magnetic attraction of frontal sinus foreign body, Otolaryngol. Head Neck Surg. 99 (1988) 76 – 78. [4] E. Volle, P. Beyer, H.J. Kaufmann, Therapeutic approach to ingested Button-type batteries, Pediatr. Radiol. 19 (1989) 114 – 118. [5] V.G. McDermot, T. Taylor, J.P. Wyatt, S. Mc Kenzie, G.M. Hendry, Orogastric magnet removal of ingested disc batteries, J. Pediatr. Surg. 30 (1995) 29 – 32. [6] J. Mayr, S. Dittrich, K. Triebl, A new method for removal of metallic – ferromagnetic foreign bodies from the tracheobronchial tree, Pediatr. Surg. Int. 12 (1997) 461 – 462. [7] H. Saito, H. Saka, S. Sakai, K. Shimota, Removal of broken fragment of biopsy forceps with magnetic extractor, Chest 95 (1989) 700 – 701. [8] G.L. Landry, M.B. Edmundson, Attractive method for battery removal, J. Am. Med. Assoc. 256 (1986) 3351 Letter. [9] R. Prasad, H.C. Amstutz, E.A. Sparling, Use of a magnet to retrieve a broken scalpel blade, J. Arthroplasty 15 (2000) 806 – 808. [10] T.J. Garfinkle, A most attractive nose, New Engl. J. Med. 338 (1998) 1474. [11] R.D. Pitetti, S. Mishra, R. Hickey, Magnet-backed earrings: not just for decoration, Pediatr. Emerg. Care 14 (1998) 208 – 209. [12] V.M.M. Ward, D. Selvadurai, A magnetic nasal attraction, J. Accid. Emerg. Med. 17 (2000) 53 – 56. [13] S.R. McCormick, P.O. Brennan, J.G. Yassa, Magnets and children —an attractive combination, Br. Med. J. 321 (2000) 7259. [14] J. Lancaster, J. Mathews, I.W. Sherman, Magnetic nasal foreign bodies, Injury Int. J. Care Injured 31 (2000) 123. [15] C.R.S. Brown, Intranasal button battery causing septal perforation: a case, J. Laryngol. Otol. 108 (1994) 589 – 590. [16] O. Palmer, B. Natarajan, A. Johnstone, S. Sheikh, Button battery in the nose —an unusual foreign body, J. Laryngol. Otol. 108 (1994) 871 –872.
Case report
Magnetic removal of a nasal foreign body Susan A. Douglas, Showkat Mirza *, Francis W. Stafford Head & Neck Surgery, Department of Otolaryngology, Freeman Hospital, Newcastle-upon Tyne, UK Received 3 August 2001; accepted 4 October 2001
Abstract We describe a case of metallic nasal foreign body removal from a child with the aid of a permanent magnet. This is the first documented case of such a technique as far as we are aware. Magnets may prove invaluable in the removal of metallic nasal foreign bodies particularly in children and avoid the need for a general anaesthetic. A brief review of the use of magnets to remove foreign bodies is included. © 2002 Elsevier Science Ireland Ltd. All rights reserved. Keywords: Foreign body; Nasal; Magnet
1. Introduction The removal of nasal foreign bodies in young children can be a traumatic experience for the patient and parents, as well as the physician involved. Young children are often resistant to the idea of sharp-looking objects, such as the forceps and hooks used by otolaryngologists, being introduced into the nose. Devices that can safely hasten and ease the process of removal may prove invaluable for patient and physician comfort. Magnets have been used to remove metallic foreign bodies from various parts of the body including the eye [1,2], frontal sinus [3], upper * Corresponding author. Present address: 38 The Ropery, St. Peters Basin, Newcastle-upon Tyne NE6 1TY, UK. Tel.: +44-191-275-9127. E-mail address: [email protected] (S. Mirza).
digestive tract [4,5], tracheobronchial tree [6,7] and external auditory meatus [8]. This is, as far as we are aware, the first report of the removal of a metallic nasal foreign body using a permanent magnet. 2. Case history A 1-year-old child presented with a short history of a right-sided metallic ball bearing nasal foreign body. The casualty officer was unable to remove the object and the child was referred to our Department of Otolaryngology. On arrival, the child was asleep. Examination of the right nasal cavity revealed the foreign body lodged between the inferior turbinate and nasal septum. A household magnet that was at hand was applied to the nostril in an attempt to remove the object but the ball bearing was too lodged in
0165-5876/02/$ - see front matter © 2002 Elsevier Science Ireland Ltd. All rights reserved. PII: S 0 1 6 5 - 5 8 7 6 ( 0 1 ) 0 0 6 0 9 - 7
166
S.A. Douglas et al. / Int. J. Pediatr. Otorhinolaryngol. 62 (2002) 165–167
place. A blunt hook loosened the object, but at this point the child awoke and became uncooperative. The magnet was again applied to the nostril and the foreign body was briskly removed with no nasal trauma (Fig. 1).
3. Discussion Magnets have been successful in the removal of foreign bodies from various anatomic locations. Volle et al. [4] and McDermott et al. [5] described the removal of disc batteries from the oesophagus and stomach in children, by the use of an orogastric magnet under fluoroscopic control. The orogastric magnet consisted of a magnet attached to the end of a long silastic tube, similar to a nasogastric tube. They found the technique to be simple, safe, well tolerated and effective, avoiding the need for general anaesthesia and surgery. Mayr et al. [6] described the use of a wire with a magnetic tip fitting into the working channel of a rigid bronchoscope in order to remove a ferromagnetic foreign body from the tracheobronchial tree of a child. In this instance a magnet may prove invaluable in the extraction of foreign bodies from the relatively small diameter paediatric airway. Ophthalmologists regularly use electromagnets [2] as well as small rare-earth magnets on the end of a thin non-magnetic introducer [1] to remove intraocular ferromagnetic foreign bodies. Landry and Edmuson [8] described the removal of a watch battery from an ear canal using a magnetized screwdriver. The removal of iatrogenic metallic foreign bodies with a magnet has been described including a broken blade during a hip arthroplasty [9] and a broken fragment of a forceps during a transbronchial lung biopsy [7]. Calhoun et al. [3] described the removal of an air gun pellet from the frontal sinus with the use of an ophthalmic foreign body electromagnet. The electromagnet had various different tip end shapes. Using an electromagnet with a curved 40-mm long tip and a flattened 2-mm wide end, allowed its insertion through a frontal sinus trephination, enabling the extraction of the pellet. A number of cases of removing magnetic earrings stuck together across the nasal septum have
recently been reported [10–14]. These patients used bilateral nasal magnetic earrings to mimic nasal piercing. Unfortunately, the two intranasal magnets became attracted to each other across the nasal septum. Garfinkle [10] described removing one magnet with a Hartmann forceps and then on reinserting the forceps, the second magnet jumped out of the nose, attracted to the metallic forceps. Pitetti et al. [11] found each magnet became attracted to a limb of a nasal bayonet forceps and both magnets were removed simultaneously by inserting one limb of the forceps into each nasal cavity. Ward and Selvadurai [12] polarized a wax hook to remove the magnets. At times a general anaesthetic may be necessary to allow removal [13]. Lancaster et al. [14] described a case where the attempted removal of the magnets was abandoned due to discomfort. Removal under a general anaesthetic was delayed by 36 h, resulting in pressure necrosis and a septal perforation. Our case represents the first description of the removal of a nasal foreign body with a permanent magnet. The magnet enabled the swift atraumatic removal of the metallic foreign body and avoided the need for a general anaesthetic. The magnet used was a 10-mm diameter neodymium magnet, at the end of a handle (Fig. 1). We have now acquired a number of magnets, including rod magnets of 3, 4 and 5 mm diameter. These are of a shape that would allow their insertion into the nasal cavity or even the external auditory meatus.
Fig. 1. A household magnet used to remove a metal ball bearing nasal foreign body.
S.A. Douglas et al. / Int. J. Pediatr. Otorhinolaryngol. 62 (2002) 165–167
167
4. Conclusion We recommend that Departments of Otolaryngology possess magnets to aid in the rapid and atraumatic removal of metallic nasal foreign bodies.
References
Fig. 2. The Alcomax III rod magnets (3, 4 and 5-mm diameters× 30-mm length) and a neodymium iron boron magnet (25-mm diameter × 7-mm axis).
In addition, we have the more powerful 25-mm neodymium iron–boron magnet, though its size precludes insertion into the nasal cavity (Fig. 2). This array of magnets may aid the removal of metallic nasal foreign bodies as well as foreign bodies in the ear canal. In addition, they may assist in the removal of the aforementioned metallic earring foreign bodies and avoid complications. It has been well documented that intranasal disc batteries, such as those found in watches and calculators, can result in tissue necrosis, septal perforation, scarring and saddle deformity [15,16]. In order to prevent these complications, the prompt removal of these foreign bodies from the nose is essential and to that end, magnets may prove invaluable. In circumstances, where the foreign body has been in place for a while, the mucosa may become friable with visualization of the foreign body proving difficult. A magnet may be particularly useful in this situation. The electromagnet has a stronger magnetic field than a permanent one and may be worth trying when a permanent magnet is unsuccessful in foreign body retrieval. Many ophthalmology departments contain an electromagnet, but these tend to be quite cumbersome and would need to be housed on the same site as the ENT department to be of practical use.
[1] G.W. Crock, P. Janakiraman, P. Reddy, Intraocular magnet of Parel, Br. J. Ophthalmol. 70 (1986) 879 – 885. [2] A.R. Irvine, Old and new techniques combined in the management of intraocular foreign bodies, Ann. Ophthalmol. 13 (1981) 41 – 47. [3] K.H. Calhoun, B.R. Peters, C.M. Steinberg, F.B. Quinn, Magnetic attraction of frontal sinus foreign body, Otolaryngol. Head Neck Surg. 99 (1988) 76 – 78. [4] E. Volle, P. Beyer, H.J. Kaufmann, Therapeutic approach to ingested Button-type batteries, Pediatr. Radiol. 19 (1989) 114 – 118. [5] V.G. McDermot, T. Taylor, J.P. Wyatt, S. Mc Kenzie, G.M. Hendry, Orogastric magnet removal of ingested disc batteries, J. Pediatr. Surg. 30 (1995) 29 – 32. [6] J. Mayr, S. Dittrich, K. Triebl, A new method for removal of metallic – ferromagnetic foreign bodies from the tracheobronchial tree, Pediatr. Surg. Int. 12 (1997) 461 – 462. [7] H. Saito, H. Saka, S. Sakai, K. Shimota, Removal of broken fragment of biopsy forceps with magnetic extractor, Chest 95 (1989) 700 – 701. [8] G.L. Landry, M.B. Edmundson, Attractive method for battery removal, J. Am. Med. Assoc. 256 (1986) 3351 Letter. [9] R. Prasad, H.C. Amstutz, E.A. Sparling, Use of a magnet to retrieve a broken scalpel blade, J. Arthroplasty 15 (2000) 806 – 808. [10] T.J. Garfinkle, A most attractive nose, New Engl. J. Med. 338 (1998) 1474. [11] R.D. Pitetti, S. Mishra, R. Hickey, Magnet-backed earrings: not just for decoration, Pediatr. Emerg. Care 14 (1998) 208 – 209. [12] V.M.M. Ward, D. Selvadurai, A magnetic nasal attraction, J. Accid. Emerg. Med. 17 (2000) 53 – 56. [13] S.R. McCormick, P.O. Brennan, J.G. Yassa, Magnets and children —an attractive combination, Br. Med. J. 321 (2000) 7259. [14] J. Lancaster, J. Mathews, I.W. Sherman, Magnetic nasal foreign bodies, Injury Int. J. Care Injured 31 (2000) 123. [15] C.R.S. Brown, Intranasal button battery causing septal perforation: a case, J. Laryngol. Otol. 108 (1994) 589 – 590. [16] O. Palmer, B. Natarajan, A. Johnstone, S. Sheikh, Button battery in the nose —an unusual foreign body, J. Laryngol. Otol. 108 (1994) 871 –872.