Feb 2008 Newsletter

Case of the Month
Jordan Pritikin, MD
Chicago Nasal and Sinus Center, Chicago, IL
www.chicagonasalsinuscenter.com
MiniCAT™ #00128

Patient is a 25 year old female with a history of nasal trauma and fracture occurring 2 years ago. She underwent surgical repair at that time, but she had been unable to breathe through her nose since then and she had constant pain and the persistent sensation of something “stuck” in her nose on the left side. When she blew her nose, she could feel something moving inside her nose, but she was unable to express anything. She had also experienced frequent sinus infections over the past 2 years, reporting that she has been on antibiotics 3 times in the past 6 months.

Nasal exam revealed left septal deviation with marked swelling of the left inferior turbinate. Despite application of pontacaine and ephedrine, the turbinate swelling persisted and nasal endoscopy revealed granulation tissue along the floor of the nose. The edge of a glistening translucent foreign body could be seen, impacted deep within the middle meatal space. Attempts to remove this foreign body in the office with an alligator forceps were unsuccessful and were stopped due to patient discomfort.

A multi-planar CT scan was performed and the results were reviewed with the patient. Septal deviation to the left was noted, with a thin line of intermediate density extending around the inferior turbinate and into the middle meatal space. This appeared to be a foreign material, isodense with the turbinate mucosa and impacted within the nasal passage. Narrowing of the maxillary infindibular spaces was also noted, but there was no fluid level or mucosal thickening.

The patient underwent septoplasty and nasal endoscopy was performed on the left side. Granulation tissue was carefully removed, exposing the foreign body impacted within the nasal passage and extending from the floor of the nose into the posterior aspect of the middle meatus. The foreign body was, in fact, an intact Reuter bi-valve nasal splint which had been placed during her nasal surgery 2 years ago. This splint was removed, the middle meatal space was irrigated with an antibiotic solution and no other abnormalities were identified.

Two days later, the patient was seen in the office for a routine post-op visit. Her nasal breathing had dramatically improved and, more importantly, her constant left-sided facial pain had resolved.

Click on the scans below for a larger view