Abstract
Objectives
We aim to present two cases of a retained insertion stylet from nasal feeding tube bridle systems.
Study design
Case series of two patients.
Methods
Patients were evaluated from 8/2012 to 9/2013 for retained bridle system insertion stylet.
Results
Two patients presented with a retained stylet from nasal tube bridle system. The patients presented one day and two months after discharge from the hospital, respectively. They were both removed at the bedside.
Conclusions
Some institutions use a bridle system to secure nasal feeding tubes. Physicians must be aware of the insertion stylet as a potential source of a retained nasal foreign body.
1
Introduction
Nasal foreign bodies are typically seen in the pediatric population and are a common occurrence in the practice of Otolaryngology . Unlike the foreign bodies into larynx and upper airway, nasal foreign bodies are rarely life threatening but can lead to significant morbidity . Nasal foreign bodies are much less common in the adult population and generally seen in patients with altered mental status secondary to organic or psychiatric etiologies. There have been case reports highlighting nasal foreign bodies introduced while the patient was intubated and sedated only to be discovered months later with significant nasal congestion, rhinorrhea and pain symptoms .
In last few years, nasal bridle kits have become increasingly popular to help secure various nasal tubes in place instead of a septal suture or adhesive tape. These kits contain a stylet that must be removed during the insertion process. Retained stylets represent a unique form of an iatrogenic nasal foreign body because they may be placed when an otherwise mentally intact patient is temporarily sedated . These patients may be misdiagnosed as having nasal congestion, rhinitis or sinusitis and therefore be mistreated for prolonged periods of time before proper diagnosis and treatment as the patient may not be aware of the potential for a foreign body.
Nasal tube bridle system insertion stylets have not been previously described as a source of nasal foreign body. We therefore aim to present two cases of iatrogenic foreign bodies secondary to a retained insertion stylet from nasal feeding tube bridle systems.
2
Case report
Two cases were identified in a 12-month period with both patients presenting to the hospital with a retained stylet from nasal tube bridle system. This study was exempt under formal review and waiver by the University of South Florida Institutional Review Board.
2.1
Case 1
The first case was a 67-year-old male who was referred to otolaryngology clinic with complaints of progressive nasal pain, congestion and odynophagia two months after discharge from the hospital. He had a prolonged hospital course requiring intubation and nasal feeding tube placement for nutrition. Nasal endoscopy was performed and revealed a plastic foreign body impacted within the left middle meatus with a green wire wrapping around the posterior septum and into the right nasal cavity ( Fig. 1 ). The soft palate would make contact with the wire upon closure of the velopharynx, thus causing his pain with swallowing ( Fig. 2 ). The foreign object could not be visualized on routine anterior rhinoscopy with a nasal speculum. Topical and then local lidocaine was used for anesthesia. The foreign body was then removed from the left nasal cavity by advancing the wire from the right nasal cavity retrograde into the nasopharynx and back through the left nasal cavity to avoid trauma to the posterior septum. The foreign body measured approximately 16 cm in length and is shown in Fig. 3 .
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