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Cases of foreign body ingestion are common among children. But impaction of ingested foreign body in nasopharynx is extremely rare. We present a male patient 4 months old with ingestion of foreign body (marble) impacted in the nasopharynx. The patient came after suspicion of his mother that he ingested marble ball but the patient had no symptoms, the patient diagnosed by X-ray head, neck and chest, the was removed immediately under general anaesthesia using finger and magill forceps.
Keywords: Foreign Body Ingestion; Nasopharynx; X-ray Head and Neck; Marble
Foreign body ingestion especially in children is a very common case that presents daily in Ear Nose and Throat departments worldwide. Foreign body ingestion can occur in any age group but more common in children as they have more tendencies to explore objects and usually they play during ingestion . Most of the ingested foreign bodies pass downward either to esophagus or to trachea [2,3]. Foreign bodies may impact in certain sites. One of the most common sites is crico-esophageal junction [2,4]. It is extremely rare to find ingested foreign body impacted in the nasopharynx [2,5]. Impaction of foreign body in nasopharyx is dangerous and may be fatal as it can easily be dropped, inhaled and cause sudden airway obstruction . Swallowed foreign bodies may impact in nasopharynx although this is against gravity, some authors attribute that due to forceful cough or vomiting or due to penetrating trauma [2,7]. We present this case of swallowed foreign body impacted in the nasopharynx which is extremely rare site of impaction of ingested foreign bodies.
4 months old male child arrived to our department with history of foreign body swallow (marble) 6 hours ago, on his mother’s words he was laying down in his bed holding a marble in his hand and suddenly he had attack of cough she harried up to her child and she didn’t find the marble ball and she suspected that he had swallowed it. she brought him directly to our department, on examination of the patient he was calm no dyspnea , stridor or drooling of saliva .oral examination was free and nasal examination was free, X -ray head, neck and chest post
anterior view and lateral view was requested. X-ray head, neck and chest lateral view shows a radio-opaque spherical foreign body impacted in the nasopharynx (Figure 1).
Urgently the patient was carried to operation room and
the foreign body was removed under general anesthesia. Boyel
Davis mouth gage was applied and pack applied in hypopharynx
around the endotracheal tube to prevent swallow or inhalation
of the foreign body during extraction. The foreign body was
removed by finger from the nasopharynx to the throat and then
picked up by magill forceps (Figure 2).
Impaction of ingested foreign body in nasopharynx is rare
but it should be kept in mind in all the case of foreign body
ingestion especially when the foreign body not found in chest
and abdominal x-ray. Urgent intervention is must to avoid drop
of the foreign body in tracheal causing fatal complications.
Nasopharynx is extremely rare site for foreign body
impaction, in chevalier Jackson’s study which includes 2000
patients who had aero digestive foreign bodies, Only 2 patients
have foreign body impacted in nasopharynx [8,9]. Most of
foreign bodies in aero digestive track take pathway downward
to either esophagus or trachea. Upward movement of ingested
foreign bodies is prevented by strong nasopharyngeal isthmus
and by effect of gravity . But in few cases foreign bodies
move upward to nasopharynx. Authors attribute this due to
forceful cough or vomiting or direct trauma [2,10]. In our case
the patient has history of cough upon ingestion of marble which
may be the cause of abnormal passage of the foreign body to
the nasopharynx. There are documented cases of coin, metallic
hair clips, marble, fish and rubber beads were found in the
All of these foreign bodies are dangerous as they can easily be
dropped and being inhaled causing sudden airway obstruction
and death. Marbles are more dangerous as they have smooth
surface and can be dropped easier. Foreign bodies in nasopharynx
may be presented by difficulty of breathing, dyspnea and nasal
discharge but may also be asymptomatic as our patient [2,7].
X-ray head, neck, chest and abdomen are mandatory to located
ingested foreign bodies. Nashopharynx shouldn’t be missed
in cases of foreign body ingestion especially when chest and abdominal X- rays are free. Urgent intervention is mandatory
in these cases and extraction under general anesthesia is more
safe, application of pack in hypopharynx around endotracheal
tube to prevent inhalation or swallowing of foreign body upon
removal may be helpful.
Nasopharynx is not a common site for foreign body impaction
after ingestion but it should be kept in mind in cases of foreign
body ingestion. X-ray head neck and chest should be a routine
investigation in cases of foreign body ingestion.