(A947) Safety First: Intraoperative Decision Making with a Nasal Foreign Body Abutting the Skull Base

Introduction: Children with nasal foreign bodies may be asymptomatic or may present with symptoms of recurrent or chronic sinusitis. The most common cause of unilateral rhinorrhea in children is a nasal foreign body.

Methods: Chart review was performed to review history, clinical, radiologic, and operative findings for this case report. A literature review was then performed.

Results: Nine-year-old male presented with one year of intermittent, right sided, purulent rhinorrhea. Episodes were associated with congestion, occasional fevers and lasted 2-3 weeks. Symptoms resolved for months between episodes. Foreign body placement was denied. Nasal endoscopy was limited due to patient tolerance and purulence in the right nasal cavity, though no foreign body was identified. Outside computed tomography (CT) head report described near opacification of the right maxillary sinus and mucosal thickening in bilateral sphenoids, ethmoids, and the left maxillary sinus. Formal images were requested for review, though were not received. Recommendations were made for nasal endoscopy and adenoidectomy. Intraoperatively, extensive granulation tissue was encountered and debrided to reveal a metallic foreign body in the right nasal cavity. The object was fixed in place. Additional debridement revealed an open safety pin with the sharp limb impaled in the floor of the nose. The other limb extended medial to the middle turbinate toward the sphenoid sinus. Intraoperative CT was obtained, which demonstrated the sharp limb traversing through the hard palate and the superior limb extended to the face of the sphenoid. Further debridement allowed for the pin to be retracted out of the hard palate and removed. Postoperative review of the CT head revealed the safety pin was visible on scout images but not on traditional cuts.

Conclusions: This case highlights the importance of reviewing all images preoperatively, including scout images; consideration for use of intraoperative CT to assess the skull base with complex foreign bodies; and having a high index of suspicion for foreign bodies in patients with unilateral rhinorrhea.