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Nasal Magnetic Foreign Body: A Sticky Topic
The Journal of Emergency Medicine, Vol. 43, No. 2, pp. 319 –321, 2012 Copyright © 2012 Elsevier Inc. Printed in the USA. All rights reserved 0736-4679/$–see front matter
doi:10.1016/j.jemermed.2010.02.013
Techniques and Procedures
NASAL MAGNETIC FOREIGN BODY: A STICKY TOPIC Benson Yeh,
MD
and James Roland Roberson,
MD
Department of Emergency Medicine, Brooklyn Hospital Center, Brooklyn, New York Reprint Address: Benson Yeh, MD, Department of Emergency Medicine, Brooklyn Hospital Center, 121 Dekalb Avenue, Brooklyn, NY 11201
e Abstract—Background: Magnetic earrings are becoming a popular item for both adults and children. In recent years, there have been case reports describing how two magnetic rings become affixed to the nasal septum. Discussion: We report the use of two cardiac pacemaker magnets and two micro polypus forceps to remove the magnetic rings via induced magnetism. Conclusions: The use of magnetized instruments demonstrates a safe and effective way to remove impacted magnetic foreign bodies from the nose. © 2012 Elsevier Inc.
the evening he had been at a bar where he was persuaded by friends to place the magnets across his nasal septum. The strong attractive force of the magnets pulled them deep into the nasal canals where he was unable to remove them with his fingers or by blowing his nose. Aside from a few drinks, the patient denied any additional drug use. The patient denied any prior medical problems. Physical examination of the nose revealed bilateral magnetic disks measuring 1 cm in diameter. The magnets were located beyond the vestibule and were adherent across the nasal septum. There were no signs of active bleeding or tissue necrosis. Initial attempts to directly grasp the magnets with alligator forceps were unsuccessful. The strong attractive force of the small magnets proved to be an obstacle in separating an individual magnet from the septal wall. To overcome this magnetic attraction, two cardiac pacemaker magnets were applied to two separate micro polypus forceps. The pacemaker magnets imparted enhanced magnetic strength to the metallic forceps. The patient was placed in an upright position. With the effort of two physicians, the apparatuses were simultaneously placed in each nostril. The pull of the magnetically enhanced forceps allowed successful separation of the magnetic jewelry and both pieces were removed without trauma to the septal mucosa (Figure 1). Minimal mucosal bleeding stopped spontaneously. Re-examination of the nasal mucosa showed no signs of necrosis or mucosal damage.
e Keywords— Nasal foreign body; septal magnetic removal
INTRODUCTION There have been multiple case reports of magnetic nasal foreign bodies. The majority of these cases occur in pediatric patients, and various methods of removal have been employed. This case reviews previously used methods and introduces an original technique for removal of magnetic foreign bodies while minimizing the risk of trauma to the delicate surrounding tissue.
CASE REPORT A 26-year-old man presented to the Emergency Department (ED) with the complaint of two magnetic disc earrings lodged in both nasal passages. Earlier in
RECEIVED: 27 February 2009; FINAL ACCEPTED: 17 February 2010
SUBMISSION RECEIVED:
7 February 2010; 319
320
B. Yeh and J. R. Roberson
Figure 3. Micro polypus forceps with magnetic rings attached.
Figure 1. Patient immediately after magnet removal.
DISCUSSION Removal of impacted magnets from the nose is an undertaking that might initially seem challenging without sophisticated tools or expert consultation. Septal damage from pressure necrosis is a well-documented complication of nasal magnet impaction (1). Urgent removal of these foreign bodies is crucial in preventing such injuries. Removal of the magnets by the emergency physician is a feasible task that obviates the need for consultation and provides appropriate care without delay. Various techniques have been attempted by emergency
Figure 2. Magnetic ring.
physicians to remove nasal magnets with tools commonly found in the ED. One series of cases describes the use of a nonferromagnetic blunt probe fashioned into a hook (2). Although this method consistently proved successful in three similar cases, exerting direct force to remove the magnets carries an obvious risk of trauma to the nasal mucosa. Other unsuccessful methods employed in a different case include the use of an inflated Fogarty balloon catheter and attempts to manually remove the magnets with bayonet forceps (3). In the same case, an otolaryngology clinic follow-up also failed to remove the magnets using the two-operator forceps technique. The patient was sent home with plans for elective removal of the magnets under general anesthesia. While awaiting this procedure, the magnets were successfully removed by the patient’s father using a simple household pocket magnetic pickup. Another case report documents the successful removal of magnets from a child’s nose using the magnetized flat metal handle of bayonet forceps (4). In the case currently under discussion, the alligator forceps possessed a weak magnetic power that was insufficient to overcome the trans-septal attraction between the magnetic earrings. The ED was not equipped with instruments that alone possessed sufficient magnetic strength to separate the magnets. Surgical instruments such as the micro polypus forceps used in our case are often composed of steel, which contains iron as a component element. Metal objects that contain iron possess the property of ferromagnetism. When such objects are placed in proximity to a magnet of sufficient strength, they exhibit their own magnetic properties by a phenomenon known as induced magnetism. Placing the pacemaker magnet in series with the
Nasal Magnetic Foreign Body
321
alligator forceps employed this physical property as a means for easily extracting the magnetic jewelry from the patient’s nose. Hemostats, needle drivers, or any other metallic medical instruments in the ED might also be used for the same purposes.
From tertiary care centers to remote regions where expert consultations are not readily available, the emergency physician may be able to provide the proper treatment in a timely manner.
CONCLUSION
REFERENCES
Notable in the cases discussed above and in this case, the use of magnetized instruments demonstrates a safe and effective way to remove impacted magnetic foreign bodies from the nose. This case introduces an approach to fashioning an adequate tool with objects commonly found in most EDs (Figures 2, 3). The implications of this technique may prove useful in EDs of all scales.
1. Lehman DA, Roy S. Septal perforation caused by magnetic foreign bodies. Ear Nose Throat J 2005;84:266 –7. 2. Bledsoe RD. Magnetically adherent nasal foreign bodies: a novel method of removal and case series. Am J Emerg Med 2008;26: 839.e1–2. 3. Starke L. Easy removal of nasal magnets. Pediatr Emerg Care 2005;21:598 –9. 4. Brown L, Tomasi A, Salcedo G. An attractive approach to magnets adherent across the nasal septum. CJEM 2003;5:356 – 8.
doi:10.1016/j.jemermed.2010.02.013
Techniques and Procedures
NASAL MAGNETIC FOREIGN BODY: A STICKY TOPIC Benson Yeh,
MD
and James Roland Roberson,
MD
Department of Emergency Medicine, Brooklyn Hospital Center, Brooklyn, New York Reprint Address: Benson Yeh, MD, Department of Emergency Medicine, Brooklyn Hospital Center, 121 Dekalb Avenue, Brooklyn, NY 11201
e Abstract—Background: Magnetic earrings are becoming a popular item for both adults and children. In recent years, there have been case reports describing how two magnetic rings become affixed to the nasal septum. Discussion: We report the use of two cardiac pacemaker magnets and two micro polypus forceps to remove the magnetic rings via induced magnetism. Conclusions: The use of magnetized instruments demonstrates a safe and effective way to remove impacted magnetic foreign bodies from the nose. © 2012 Elsevier Inc.
the evening he had been at a bar where he was persuaded by friends to place the magnets across his nasal septum. The strong attractive force of the magnets pulled them deep into the nasal canals where he was unable to remove them with his fingers or by blowing his nose. Aside from a few drinks, the patient denied any additional drug use. The patient denied any prior medical problems. Physical examination of the nose revealed bilateral magnetic disks measuring 1 cm in diameter. The magnets were located beyond the vestibule and were adherent across the nasal septum. There were no signs of active bleeding or tissue necrosis. Initial attempts to directly grasp the magnets with alligator forceps were unsuccessful. The strong attractive force of the small magnets proved to be an obstacle in separating an individual magnet from the septal wall. To overcome this magnetic attraction, two cardiac pacemaker magnets were applied to two separate micro polypus forceps. The pacemaker magnets imparted enhanced magnetic strength to the metallic forceps. The patient was placed in an upright position. With the effort of two physicians, the apparatuses were simultaneously placed in each nostril. The pull of the magnetically enhanced forceps allowed successful separation of the magnetic jewelry and both pieces were removed without trauma to the septal mucosa (Figure 1). Minimal mucosal bleeding stopped spontaneously. Re-examination of the nasal mucosa showed no signs of necrosis or mucosal damage.
e Keywords— Nasal foreign body; septal magnetic removal
INTRODUCTION There have been multiple case reports of magnetic nasal foreign bodies. The majority of these cases occur in pediatric patients, and various methods of removal have been employed. This case reviews previously used methods and introduces an original technique for removal of magnetic foreign bodies while minimizing the risk of trauma to the delicate surrounding tissue.
CASE REPORT A 26-year-old man presented to the Emergency Department (ED) with the complaint of two magnetic disc earrings lodged in both nasal passages. Earlier in
RECEIVED: 27 February 2009; FINAL ACCEPTED: 17 February 2010
SUBMISSION RECEIVED:
7 February 2010; 319
320
B. Yeh and J. R. Roberson
Figure 3. Micro polypus forceps with magnetic rings attached.
Figure 1. Patient immediately after magnet removal.
DISCUSSION Removal of impacted magnets from the nose is an undertaking that might initially seem challenging without sophisticated tools or expert consultation. Septal damage from pressure necrosis is a well-documented complication of nasal magnet impaction (1). Urgent removal of these foreign bodies is crucial in preventing such injuries. Removal of the magnets by the emergency physician is a feasible task that obviates the need for consultation and provides appropriate care without delay. Various techniques have been attempted by emergency
Figure 2. Magnetic ring.
physicians to remove nasal magnets with tools commonly found in the ED. One series of cases describes the use of a nonferromagnetic blunt probe fashioned into a hook (2). Although this method consistently proved successful in three similar cases, exerting direct force to remove the magnets carries an obvious risk of trauma to the nasal mucosa. Other unsuccessful methods employed in a different case include the use of an inflated Fogarty balloon catheter and attempts to manually remove the magnets with bayonet forceps (3). In the same case, an otolaryngology clinic follow-up also failed to remove the magnets using the two-operator forceps technique. The patient was sent home with plans for elective removal of the magnets under general anesthesia. While awaiting this procedure, the magnets were successfully removed by the patient’s father using a simple household pocket magnetic pickup. Another case report documents the successful removal of magnets from a child’s nose using the magnetized flat metal handle of bayonet forceps (4). In the case currently under discussion, the alligator forceps possessed a weak magnetic power that was insufficient to overcome the trans-septal attraction between the magnetic earrings. The ED was not equipped with instruments that alone possessed sufficient magnetic strength to separate the magnets. Surgical instruments such as the micro polypus forceps used in our case are often composed of steel, which contains iron as a component element. Metal objects that contain iron possess the property of ferromagnetism. When such objects are placed in proximity to a magnet of sufficient strength, they exhibit their own magnetic properties by a phenomenon known as induced magnetism. Placing the pacemaker magnet in series with the
Nasal Magnetic Foreign Body
321
alligator forceps employed this physical property as a means for easily extracting the magnetic jewelry from the patient’s nose. Hemostats, needle drivers, or any other metallic medical instruments in the ED might also be used for the same purposes.
From tertiary care centers to remote regions where expert consultations are not readily available, the emergency physician may be able to provide the proper treatment in a timely manner.
CONCLUSION
REFERENCES
Notable in the cases discussed above and in this case, the use of magnetized instruments demonstrates a safe and effective way to remove impacted magnetic foreign bodies from the nose. This case introduces an approach to fashioning an adequate tool with objects commonly found in most EDs (Figures 2, 3). The implications of this technique may prove useful in EDs of all scales.
1. Lehman DA, Roy S. Septal perforation caused by magnetic foreign bodies. Ear Nose Throat J 2005;84:266 –7. 2. Bledsoe RD. Magnetically adherent nasal foreign bodies: a novel method of removal and case series. Am J Emerg Med 2008;26: 839.e1–2. 3. Starke L. Easy removal of nasal magnets. Pediatr Emerg Care 2005;21:598 –9. 4. Brown L, Tomasi A, Salcedo G. An attractive approach to magnets adherent across the nasal septum. CJEM 2003;5:356 – 8.