Article
An occult, retained foreign body parapharyngeal
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Authors
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Bernd Reuter
- Klinik für Hals-, Nasen- und Ohrenkrankheiten/ Plastische Operationen, SRH Zentralklinikum Suhl gGmbH, Suhl, Germany
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Peter Lochner
- Klinik für Hals-, Nasen- und Ohrenkrankheiten/ Plastische Operationen, SRH Zentralklinikum Suhl gGmbH, Suhl, Germany
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Daniel Böger
- Klinik für Hals-, Nasen- und Ohrenkrankheiten/ Plastische Operationen, SRH Zentralklinikum Suhl gGmbH, Suhl, Germany
| Published: | August 3, 2011 |
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Outline
Text
History: A forestry worker was administrated to our department with an injury to the ear due to the impact of a piece of wood on the head
Physical examination: There was a laceration in the right cavum conchae (1.5 cm) with smooth wound edges without significant bleeding. Furthermore there was a limited mouth opening with otherwise unremarkable intraoral findings. The ultrasonography of the region showed no signs of a foreign body or a hematoma.
Course: Wound care in local anesthesia was immediately administrated to the patient. Bleeding from the wound associated with a hypotonic dysregulation occurred on the next day. ACT showed a hypodense area parapharyngeal. Immediate wound revision and pharyngoscopy was performed and a 1.3 cm thick and 10 cm long wooden stick was found, which reached from just below the port of entry in the cavum conchae, through a mucosal teal at the lower pol of the tonsil to the preepiglottic area. After transoral removal a violation of the large neck vessels was excluded by CT angiography. The further course of the patient was uneventful.
Summary: A staking injury occurred during which a large foreign body entered through a small, inconspicuous wound in the cavum conchae into the soft tissues of the neck, was then deflected by the lower jaw and perforated the mucosa at the lower pol of the tonsil. The history was indicative of only a crash injury from a wooden block. Only in CT suspicious soft tissue findings were found.
Conclusion: Careful anamnesis and clinical findings (lockjaw, fiberoptic examination), more generous use of imaging diagnostics in traumatology! In particular when confronted with staking injuries an occult, retained foreign body should be always sought for.
