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PubMed2003

External auditory canal foreign body removal: management practices and outcomes.

OBJECTIVES/HYPOTHESIS: The purpose of the study was to evaluate the effectiveness of external auditory canal foreign body removal attempts by health care practitioners and to explore outcomes of patients with unsuccessful initial removal attempts. STUDY DESIGN: Retrospective case series. METHODS: A case series of patients presenting with external auditory canal foreign body to the emergency department of the authors' institution (Strong Memorial Hospital, University of Rochester Medical Center) over a 3-year period was studied retrospectively. Medical records were reviewed, and information including age at presentation, type of foreign body, side of presentation, length of time in place, signs and symptoms at presentation, management practices, and outcomes was recorded. RESULTS: One hundred sixty-two patients with a diagnosis of external auditory canal foreign body were identified. Emergency personnel successfully managed 67% of patients using direct visualization techniques, and 33% required otolaryngological consultation. Otolaryngologists used otomicroscopy with standard otological instruments as their mainstay of management. Analysis of successfully managed emergency department cases revealed that 82% of foreign bodies were irregularly shaped objects with soft, graspable parts. Conversely, 72% of foreign bodies in otolaryngology referrals were firm, rounded objects such as beads and beans. Analysis of patients referred to otolaryngologists revealed a requirement for removal under anesthesia of 19%. Patients with a history of one or more removal attempts before emergency department evaluation universally failed further direct visualization techniques. A disproportionate number of these patients eventually required operative intervention and/or had tympanic membrane perforation. Patients with a history of previous removal attempt(s) who were referred directly to otolaryngologists were more likely to be successfully managed without general anesthesia. CONCLUSION: Emergency room personnel successfully manage the majority of patients with foreign bodies of the external auditory canal. For patients with firm, rounded objects, direct otolaryngology consultation without further manipulation should be strongly considered. Patients who have had previous removal attempts should not undergo further manipulation in the emergency department but rather should be referred directly to an otolaryngologist.

Adolescent↗
PubMed2008

[Lateral pharyngotomy--a rare method of access for removing foreign bodies from the upper third of the esophagus].

Esophageal foreign body impaction is a serious emergency. Diagnostic workup includes an exact history and physical examination as well as several imaging modalities. The extraction of an esophageal foreign body can be done using nonflexible or flexible esophagoscopy. We report on a 43-year-old patient with typical symptoms of esophageal foreign body impaction. The x-ray overview upon admission showed the adjustment wires of one component of a metal denture in the area of the upper esophagus. Extraction by nonflexible esophagoscopy was rendered impossible because parts of the denture had speared themselves into the esophageal wall. Safe and uncomplicated removal was then performed through a lateral pharyngotomy.

Adult↗
PubMed1984

Pediatric gastrointestinal foreign body ingestions.

One hundred twenty-five consecutive emergency department cases of pediatric gastrointestinal foreign body ingestions were analyzed retrospectively to tabulate data, identify high risk ingestions, and draw conclusions regarding the standard of care. Eleven patients (9%) were admitted for endoscopy or observation of high risk situations. Twenty patients (16%) were managed invasively, 19 with esophageal foreign bodies; 17 of 20 attempts at invasive management were successful. There was a 2% incidence of minor complications; no major complications (perforation, obstruction, bleeding, or mediastinal infection) or complications of invasive procedures were observed. High risk factors identified included the following: 1) the ingestion of rounded objects (esophageal impaction); 2) the presence of social, developmental, or psychiatric risk factors (29.6% incidence); and 3) esophageal disease (significantly associated with recurrent foreign bodies and frequent endoscopy or other surgical procedures). We conclude that, while asymptomatic gastric and intestinal foreign bodies can be managed with outpatient observation, hospitalization is indicated for endoscopic management and for symptom complexes suggestive of complication. Immediate endoscopy is recommended for removal of esophageal foreign bodies and for direct evaluation of the esophagus.

Adolescent↗
PubMed2001

Assessment of intraocular foreign bodies by helical-CT multiplanar imaging.

The aim of this study was to examine the effectiveness of helical CT in the assessment of intraocular foreign bodies, evaluating two protocols with different collimation. We performed helical-CT studies in 30 patients. Fifteen patients were examined with 1.5-mm collimation and the other 15 patients with 3.0-mm collimation. All other imaging parameters were identical in both protocols. Multiplanar images were reconstructed. The examinations were reviewed for presence, localization and size of intraocular foreign bodies. We compare our results with the surgical data. We estimate the required examination time. In the first group (collimation 1.5 mm) an intraorbital foreign body was detected in 8 of 15 patients. In 3 of 8 patients an intraocular foreign body (all were metallic) was detected. In the second group (collimation 3.0 mm) an intraorbital foreign body was detected in 9 of 15 patients. In 8 of 9 patients an intraocular foreign body (all were metallic) was detected. Our results were confirmed by surgery in all cases. Examination time was 36 s in the first group and 18 s in the second group. Computed tomography should be considered the imaging modality of choice in the assessment of metallic intraocular foreign bodies and 3.0-mm collimation is optional, because of reduced examination time and radiation exposure.

Adult↗
PubMed1992

Detection and management of foreign bodies in soft tissue.

The discovery and management of foreign bodies in soft tissue are challenging problems for emergency physicians. History, physical examination, and thorough wound exploration serve as the screening test for the presence of foreign bodies. Various radiographic studies can be performed to confirm the diagnosis, to identify the object's composition and shape, and to determine its approximate location in the tissues. Once the object is discovered, the clinician must weigh the potential harm of the foreign body in its current location against the risks of attempting removal.

Extremities↗
PubMedDate not supplied

Foreign body gingivitis associated with a new crown: EDX analysis and review of the literature.

Gingival inflammation associated with foreign bodies in connective tissue is termed Foreign Body Gingivitis (FBG). It is not commonly recognized by clinicians and has recently been described fully in the literature. It is more common in females, and the incidence by age follows a normal distribution, unlike bacterially-induced gingivitis. Most frequently, a red or red-and-white painful, chronic lesion, it has usually been present for less than one year and does not resolve with optimization of oral hygiene. It may be clinically confused with lichen planus. There is no gingival site predilection. Microscopically, foreign bodies are associated with the gingival inflammation, and elemental analysis suggests that they are usually derived from abrasives, and less commonly from restorative materials. Treatment of FBG is still unclear and its prevention is discussed. A case is presented in which a patient developed localized foreign body gingivitis after placement of a crown. Elemental analysis using energy dispersive X-ray microanalysis (EDX) of the foreign particles was most consistent with an abrasive material.

Adult↗
PubMed2006

Multiple laryngeal foreign bodies composed of dried fish vertebral bones: a case report.

We present a rare case of tracheostomy for removal of laryngeal foreign bodies consisting of three connected fish vertebral bones in a 15-month-old girl. Recent endoscopic techniques have made it possible to extract nearly all tracheobronchial foreign bodies with rigid bronchoscopes. However, the three connected foreign bodies in this report could not be extracted entirely by single endoscopy because the glottis as an exit was narrow due to severe oedema. Accordingly, tracheostomy was required to assist ventilation, prevent prolonged post-operative endotracheal intubation, remove the secondary tracheal foreign bodies and to provide a conduit for the introduction of a bronchoscope. This suggests that tracheostomy should be considered to avoid the potential dangers of severe laryngeal oedema and to secure the route for removal of foreign bodies from the trachea when treating patients with multiple laryngeal foreign bodies and laryngeal oedema.

Animals↗
PubMed1999

Unusual orbital foreign bodies.

PURPOSE: To describe the clinical features of patients with unusual orbital foreign bodies. METHODS: The clinical histories, preoperative photographs, imaging studies, and surgical pathologic findings of five patients with unusual orbital foreign bodies are presented. Additionally, published reports pertaining to similar cases were reviewed. RESULTS: The five patients treated by the authors had good outcomes. CONCLUSIONS: An orbital foreign body may be overlooked because a small penetrating wound may be accompanied by minimal or no signs of inflammation early in the clinical course. A careful history and physical examination, imaging studies, and a strong suspicion are helpful for establishing the diagnosis of an orbital foreign body.

Adolescent↗
PubMed2005

Emergency maxillofacial radiology. Foreign body localization: report of cases.

Successful emergency removal of foreign bodies of the maxillofacial complex depends on the surgeon's ability to perform exact location procedures. In hospitals and/or offices where advanced imaging technologies are not available, the attendant clinician has to use and rely on variations of conventional radiographic techniques in order to complement the diagnosis and locate the foreign body. Three cases are presented where unconventional radiographic techniques were used, leading to successful surgical removal of foreign bodies.

Adolescent↗
PubMed1996

[Ultrasound imaging of foreign bodies--an experimental study].

In an experimental study, the US pattern of foreign materials such as are often found in wounds, was investigated. The exploration was carried out with the aid of high-resolution, mechanical US probes (10-12 MHz) used to examine foreign bodies placed in a gelatine bath and in the shoulder of a pig. The study showed that all foreign bodies that measured at least 1-2 mm in diameter were reliably detected. The intensity of the interface echoes was identical with all the materials employed, irrespective of the nature of the surface. However, the artefacts caused by the foreign bodies used revealed considerable differences. Complete acoustic shadow, acoustic attenuation, reverberation echoes and even "comet-tail" artefacts were observed. In clinical practice, familiarity with the artefacts that may be expected during sonographic exploration and localization of foreign bodies in wounds would seem to make good sense.

Animals↗
PubMed1990

Laryngeal foreign bodies.

This paper presents our experience with four cases of impacted laryngeal foreign bodies. A review of the literature reveals that the condition is rare, but far more dramatic and life threatening than bronchial foreign bodies. The history may not indicate the diagnosis, especially in the ethnic minority races where there is a language barrier. Suspicion of the diagnosis by the casualty officer and the immediate attendance of an experienced otolaryngologist may be life saving. Radiological examination is not necessary where the diagnosis is obvious. If the diagnosis is in doubt it must be remembered that many foreign bodies are not radio-opaque. The patient must be accompanied at all times by an otolaryngologist until the foreign body is removed.

Child↗
PubMed1999

Thoracic foreign bodies in adults.

AIM: The aim of this pictorial essay is to illustrate a range of imaging manifestations of thoracic foreign bodies. METHODS AND RESULTS: The essay includes documented intrathoracic foreign bodies introduced by inhalation, aspiration, penetrating trauma or ingestion. Imaging modalities include chest radiography and computed tomography (CT). CONCLUSIONS: The majority of foreign bodies are seen on the plain chest radiograph. CT is helpful in demonstrating the presence of radiolucent foreign bodies and determining the exact location of the foreign bodies within the airways or lung parenchyma.

Adult↗
PubMed2003

Foreign body aspiration in children: diagnosis and treatment.

A total of 235 children, aged between 7 months and 15 years had bronchoscopy on suspicion of foreign body aspiration. The histories of these patients were studied to examine the diagnostic value of symptoms, signs, and chest x-rays, and rate of negative bronchoscopy. The sensitivity of choking and coughing was high (82% and 80%), but the specificity was poor (37% and 34%). The sensitivity of a chest radiograph was 66%, the specificity was 51%. The sensitivity of asymmetric auscultation was 80% and specificity was 72%. The sensitivity and specificity of combination of symptoms, signs and abnormal chest radiograph was 61% and 83%, respectively. In 206 (87.7%) children a foreign body was identified and extracted. The remaining 29 patients (12.3%) had negative bronchoscopy. A wide variety of objects was recovered, the most common being seeds and peanuts. Foreign bodies were in the right and left main bronchus in 72 (35%), 50 (24.3%) cases, respectively, while in the remaining 84 cases, the foreign bodies were in other parts of the respiratory tree. In 204 (99%) patients with foreign body aspiration, the foreign bodies were removed successfully using a rigid bronchoscopy. Minor complications like subglottic edema and bronchospasm occurred in 4 children. In conclusion, rigid bronchoscopy is a safe procedure and the only tool that will give certainty about the correct diagnosis of foreign body aspiration in children. Asymmetric auscultation is more specific than history and chest radiograph. The combination of history, clinical signs and radiological signs are more specific than each one separately.

Adolescent↗
PubMed2002

Application of perfluorocarbon liquid in the removal of metallic intraretinal foreign bodies.

BACKGROUND: Virectomy is recognized as one of the best effective methods for removing interetinal foreign bodies, but many authors showed complications during or after removing IOFB. The purpose of our study was to show that the use of perfluorocarbon liquid minimizes complications during pars plana vitrectomy for the removal of metallic intraretinal foreign bodies (IRFBs). MATERIAL/METHODS: Fourteen consecutive eyes presenting with penetrating eye injury and intraretinal foreign bodies had previously undergone vitrectomy with injection of perfluorocarbon liquids and removal of IRFBs. In all cases a silicon oil or gas C3F8 tamponade was performed. In one case the removal of the foreign body was combined with repair of retinal detachment using internal tamponade with silicon oil. RESULTS: After a mean follow-up of 16.4 months, 78.5% of the eyes had recovered better than 20/70 vision, and 92.8% had attached retina. One patient had endophthalmitis and phthisis, and perioperative complications were encountered in two cases. In one case there was a limited hemorrhage, intraretinal, while the other complication was a retinal detachment, which was immediately corrected. In the follow-up period endophthalmitis and lens opacity was found in one patient and epiretinal membrane in another case. These postoperative complications were repaired by additional surgery. CONCLUSIONS: The usage of perfluorocarbon liquid is effective for removal of intraretinal foreign bodies, and allows to minimize intraoperative complications.

Adult↗
PubMed2004

Combined clear cornea phacoemulsification, vitrectomy, foreign body extraction, and intraocular lens implantation.

AIM: To analyze the outcome of combined clear cornea phacoemulsification, vitrectomy, foreign body extraction, and intraocular lens implantation in patients with traumatic cataract and intraocular foreign body. METHODS: Retrospective analysis included the results of combined cataract and vitreoretinal surgery in 16 patients. All patients had a penetrating eye injury, traumatic cataract, and intraocular foreign body. Twelve patients had a corneal entry site and in 4 patients intraocular foreign body entered through the sclera. RESULTS: After a mean follow-up of 25.2 months, 10 out of 16 patients had a visual acuity of 0.1 or better. Postoperative complications were encountered in 4 patients: 2 patients had retinal detachment, one had a massive retinal fibrosis, and one developed postoperative endophthalmitis. CONCLUSION: Simultaneous posterior chamber intraocular lens implantation with vitreoretinal surgery is safe in certain cases of severe ocular trauma due to intraocular foreign body. Visual outcome was mainly related to the underlying posterior segment pathology.

Adolescent↗
PubMed1990

Death, after swallowing and aspiration of a high number of foreign bodies, in a schizophrenic woman.

A 46-year-old woman who had had a long-term schizoid psychosis collapsed on the street. Upon admission to the hospital, she was determined to have an acute abdomen. The chest radiograph showed metallic foreign bodies in both main bronchi; foreign bodies in the stomach were not observed clinically. The woman died from repeated cardiac arrest shortly after hospital admission. At the autopsy a screw and a nail were found in both main bronchi. The abdominal cavity contained 2 L of greenish purulent fluid and a massive fibrinoid peritonitis was observed. Two perforations of the stomach, each 1 cm in diameter, were detected. The stomach was completely filled with a mass of metallic foreign bodies, greenish fluid, and a bezoar of a total weight of 1,400 g; 422 distinguishable and mostly metallic foreign bodies were counted. Death was attributed to cardiac arrest in delayed shock after massive purulent peritonitis caused by two gastric perforations combined with obstruction of the airways by aspirated foreign bodies. Cases of massive swallowing of foreign bodies are mainly restricted to mentally handicapped persons, especially schizophrenics, whereas acute impaction of the larynx by large food particles occurs nearly exclusively in heavily intoxicated adults.

Abdomen, Acute↗
PubMed1976

[Present status of locating intraocular foreign bodies (author's transl)].

The different procedures used today to locate intraocular foreign bodies are discussed. The x-ray procedure is not adequate for splinters near the wall, questionable double perforations and foreign bodies which cannot be demonstrated radiographically. Complementary methods of examination such as transillumination, electroacustic location, ultrasonics and direct radio-optic controls must be used. Advantages and limitations of these individual locating procedures are discussed. Intensive transillumination with glass-fiber diaphanoscope is particularly important for splinters in the anterior section of the eyeball near the wall. Ultrasonics cannot be replaced by other methods for foreign bodies in the posterior section of the eyeball which do not produce shadows, demonstration of the relationship of the foreign body to pathologic intraocular structures and the measurement of the length of the eyeball. At the University Ophthalmic Hospital in Cologne, direct radio-optic controls are conducted with a stereo-x-ray image amplitier, a stereoscopic image that gives.

Eye Foreign Bodies↗