Sagaya Fernando
Mumbai: 7 January 2019
In a bizarre case, doctors at BR Life SUT Hospital at Thiruvananthapuram, Kerala in India, removed a plastic button lodged in the nasal cavity of a 22-year-old woman. The young woman was having acute breathing difficulty and there was a foul smell emanating from her nose for the last twenty years.
It is believed that the button got lodged in her nose when she was aged one or two years. The difficulties increased as she grew.
Though her parents tried all possible treatments, none of them gave her relief. Recently, she decided to try her luck with the ENT department of BR Life SUT Hospital.
Dr Ammu Sreeparvathi, the Associate Consultant at the hospital’s ENT Dept, found that the growth inside the patient's nose and the bad smell from it was very unusual and went for detailed investigations, including a scan.
She felt sure that there was a ‘foreign body’ inside that growth and conducted a Rhinolith surgery to remove it.
“The patient had approached me on December 12 with complaints of halitosis for many years, and as her marriage was at the end of the month her relatives had thought it fit to get the condition treated before that. As she had this complaint since many years she was shown to local hospitals and evaluated in dental, gastro-medicine and ENT departments. According to the patient she was always given multiple courses of antibiotics as it was considered as sinusitis, with which she had temporary relief for few days following which halitosis re-occurred,” said Dr Sreeparvathi.
She added, “On examination, her oral cavity and oropharynx were within normal limits. Her nasal cavity showed unilateral (right) mucoid discharge. A diagnostic nasal endoscopy was done and mucoid discharge was suctioned out and a greyish mass was seen. On palpating it with a probe it was found stony hard (rhinolith) and painful for the patient.”
“As this was unusual for a 22-year-old, a CT PNS was suggested”, said Dr Sreeparvathi.
The CT scan conducted by consultant radiologist Dr Manju Annie Rajan revealed a rounded foreign body with surrounding dense irregular calcific margins, measuring 16 mm x 18 mm x 6 mm in the posterior aspect of the right nasal cavity.
In the light of the findings the patient and her family members were enquired regarding any history of insertion of foreign body in the nose but neither the patient nor the relatives had any memory of such an incident.
“The Endoscopic Rhinolith removal under general anaesthesia was carried out on December 13. The procedure lasted for about 45 minutes. On endoscopy the choana of the right nasal cavity was not visualised due to the mass. For easy maneuvering the inferior turbinate on the right side was outfractured and the rhinolith was broken into pieces and removed with Tilley forceps, wherein a blackish-brown foreign body was noted within the rhinolith and was maneuvered out with a LUCS forceps and removed completely,” said Dr Sreeparvathi.
When it was removed, the pus collected for long drained out. After removal, the foreign body was identified as a button measuring 1.7 cm diameter with 6 mm thickness at centre portion.
“The area, where the button had got lodged, had granulation and minimal bleeding was noted. Multiple saline washes were given post-procedure and hemostasis achieved. The patient was stable post-operatively and discharged the very next day with oral antibiotics and nasal wash,” said Dr Sreeparvathi.
After the button was removed, the patient her relatives were surprised and relieved. The patient was in a shock as she had never expected a button to be in her nose for so long with no memory of inserting it.
“A week after the surgery, the patient was reviewed. She is very happy as her halitosis and the foul smell surrounding her had disappeared and was confidant to step into marriage bliss,” informed Dr Sreeparvathi.
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