Management of an Unusual Intranasal Foreign Body Abutting the Cribriform Plate: A Case Report and Review of Literature

Abstract

A 35-year-old man with history of schizophrenia presented 3 weeks after placing a screw in his right nostril. Initial imaging showed a screw in the right ethmoid sinus with the tip penetrating the right cribriform plate. On exam, the patient was hemodynamically stable with purulent drainage in the right nasal cavity but no visible foreign body. While most nasal foreign bodies occur in children and are generally removed at the bedside, intranasal foreign bodies in adults tend to require further assessment. The foreign body in this case was concerning for skull base involvement and the patient was brought to the operating room (OR) with neurosurgery for endoscopic sinus surgery (ESS) and removal of foreign body. The screw was removed and the patient recovered with no signs of cerebrospinal fluid (CSF) leak postoperatively. Any concern for skull base or intracranial involvement should call for a full evaluation of the mechanism of injury and intervention in a controlled environment.

Orbitoethmoidal foreign body through traumatic penetrating orbital injury

“…In addition to sufficient tetanus prophylaxis, preoperative antibacterial therapy is crucial for preventing infections caused by contaminated foreign bodies and should be started as early as possible. However, there are conflicting recommendations regarding the use of prophylactic antibiotics (4,7) . The surgical approach to extraction greatly depends on the nature of the foreign body, its location (anterior or posterior orbit), and related complications (infections, optic nerve lesions or compression, and injury to the extraocular nerve or intraorbital blood vessels) (8) .…”

“…The surgical approach to extraction greatly depends on the nature of the foreign body, its location (anterior or posterior orbit), and related complications (infections, optic nerve lesions or compression, and injury to the extraocular nerve or intraorbital blood vessels) (8) . Many reports of endoscopic removal of foreign bodies in adults have been published since the advancement of transnasal endoscopic surgery in the 1980s (7) . Recent developments in endonasal techniques may improve outcomes by enhancing the speed and precision of surgery, which will reduce post-operative complications, morbidity and mortality, and shorten patients' hospital stays (9) .…”

A comparative analysis of the CP and CG using 2D and 3D visualisation approaches

“…Cerebrospinal Fluid (CSF) leaks may also occur due to meningeal damage or following the olfactory epithelium being severed (Kühnel and Reichert 2015 ), causing headaches, stroke (Shah et al 2017 ) and meningitis, which can have high morbidity rates (Oh et al 2017 ). Lastly, CP fractures may result in traumatic brain injuries, especially when a transnasal-penetrating injury has occurred (Gray et al 2019 ; Teng et al 2019 ; Yoneoka et al 2020 ). These types of fractures are most commonly diagnosed using 2D CT scans (Gray et al 2019 ; Douglas and White 2021 ; Knížek et al 2021 ), however, in recent years 3D Reconstructed CT scans have been used to diagnose CP fractures (Teng et al 2019 ).…”

“…Lastly, CP fractures may result in traumatic brain injuries, especially when a transnasal-penetrating injury has occurred (Gray et al 2019 ; Teng et al 2019 ; Yoneoka et al 2020 ). These types of fractures are most commonly diagnosed using 2D CT scans (Gray et al 2019 ; Douglas and White 2021 ; Knížek et al 2021 ), however, in recent years 3D Reconstructed CT scans have been used to diagnose CP fractures (Teng et al 2019 ).…”

Cone Beam Computed Tomography for Detection of Intranasal Foreign Bodies

“…French et al recommend in their work that increased efforts should be made to restrict child access to beads, pearls, marbles, button batteries, coins and nuts and seeds [5]. In adult patients, however, the mechanism and force of entry must be considered as there is a greater chance of violation of the skull base and possible cerebrospinal fistula [6].…”