Foreign bodies in aerodigestive tract are common entity but in nasopharynx it’s very rare to find an impacted foreign body.The anatomical structure of nasopharynx prevents any lodgement of foreign body. It is capacious and having nasopharyngeal sphincter preventing regurgitation of foreign body from oropharynx. Through nasal cavity foreign body cannot travel to nasopharynx as the former is narrower.

1. Unexpected Nasopharyngeal Foreign Body

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Case Report
Unexpected nasopharyngeal foreign body
Sanjeev Gupta*, Surya Kanta Pradhan
Department of ENT e Head Neck Surgery, Apollo Hospitals, 251, Sainik School Road, Unit-15, Bhubaneswar 751005,
Orissa, India
article info
abstract
Article history:
Nasopharynx is a rare area to find a foreign body because of its location and structure. We
Received 28 September 2013
are reporting a case of impacted foreign body in nasopharynx in a 13 months old child.
Accepted 5 November 2013
Copyright ª 2013, Indraprastha Medical Corporation Ltd. All rights reserved.
Available online 23 November 2013
Keywords:
Nasopharynx
Foreign body
Tooth brush
CT-scan
1.
Introduction
Foreign bodies in aerodigestive tract are common entity but in
nasopharynx it’s very rare to find an impacted foreign body
(FB). The anatomical structure of nasopharynx prevents any
lodgement of foreign body. It is capacious and having nasopharyngeal sphincter preventing regurgitation of FB from
oropharynx. Through nasal cavity FB cannot travel to nasopharynx as the former is narrower. Most of the FB gets
impacted as a result of forceful emesis, coughing, penetrating
trauma or manoeuvre for removal of FB from oropharynx.
2.
Case report
A 13 months old male child came to our OPD with complaints
of mild difficulty in breathing, excessive salivation and nausea
for one day. He was having history of playing with a tooth
brush and he fell down on his face while the brush was inside
the oral cavity. The bristle part of the brush remained inside
and got lost while the remaining part came out. After few
hours he developed the above symptoms and they decided to
take medical help. The local medical practitioner advised for
X-ray neck, chest and abdomen. The FB was not visualised in
the radiograph and he was unable to localise it. After that he
was referred to a medical college where he was examined and
suspected to have FB in bronchus or trachea and referred to us
for removal by bronchoscopy.1
On examination the child was irritable. The vitals were
maintained. Mild respiratory distress was present but with
bilateral normal air entry and no stridor. Ear, nose and throat
were normal on examination. Nasal endoscopy or nasopharyngoscopy could not be done as the child was very small and
irritable. We advised for CT Neck with reconstruction suspecting a radiolucent FB in aerodigestive tract. To our surprise
* Corresponding author. Tel.: þ91 8093060206 (mobile).
E-mail addresses: drsanjeev_g@apollohospitals.com, sanjeevapollo@yahoo.com (S. Gupta).
0976-0016/$ e see front matter Copyright ª 2013, Indraprastha Medical Corporation Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.apme.2013.11.001

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Fig. 3 e Brush head after removal.
Fig. 1 e CT-scan showing impacted brush in the
nasopharynx.
the FB (broken tooth brush) was found to be impacted in the
nasopharynx (Figs. 1 and 2).
Patient was taken for removal of FB under GA. He was
placed in Rose’s position and BoyleseDavis mouth gag
applied. The nasopharynx was approached trans-orally. The
soft palate was retracted upwards by the anterior pillar
retractor. The lower part of the FB was visualised. It was firmly
stuck in the nasopharynx. It was gently manipulated using a
blunt dissector and the FB was brought into the oropharynx
and then removed without any trauma to nasopharynx. The
311
nasopharynx was examined using 70 telescope. As it was a
large FB we did not use nasal endoscope for accessing the FB.
The patient was discharged on the same evening without any
intra-operative or postoperative complications (Fig. 3).
3.
Discussion
Foreign body nasopharynx in such a small baby is rare. Most of
the patients present as nasal obstruction, nasal discharge
with or without any breathing or swallowing difficulty but
some remain asymptomatic for a longer period and present
mimicking adenoid hypertrophy and sinusitis.2,3 Most of the
patients can be diagnosed using flexible nasopharyngoscope
or nasal endoscopes.4 In case of a lost FB, radiography should
include X-ray of nasopharynx along with neck, chest and
abdomen.5 Computed tomography and magnetic resonance
imaging could be helpful in selective cases with radiolucent
foreign bodies.
Foreign body in nasopharynx should be kept in mind as a
differential diagnosis in case of a lost FB which may cause
fatal complications if not removed timely. It may dislodge
from the site during coughing, sneezing or manual removal
causing obstruction to larynx and respiratory arrest.
Conflicts of interest
All authors have none to declare.
references
Fig. 2 e 3D reconstruction of CT-scan showing brush below
base of skull.
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