How Plastic and Endoscopic Assisted Surgery Can Help Foreign Body Removal?
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CLINICAL REPORT
How Plastic and Endoscopic Assisted Surgery Can Help Foreign Body Removal? Seyed Behzad Pousti • Farzad Izadi Neda Nikpour • Amir Shirali
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Received: 16 June 2008 / Accepted: 8 August 2008 Ó Association of Otolaryngologists of India 2011
Abstract In this study we report a case with foreign body in the infratemporal fossa. The anatomic position of this region and the presence of important neurovascular structures make this region a sophisticated one. Commonly used open procedures can have morbidity of neurovascular system. To prevent probable complications like facial nerve injury in this case which was the most important factor for us, we decided to remove the foreign body under endoscopic guide. Keywords Foreign body Endoscopic surgery Infratemporal fossa
Introduction An increasing number of reports describe the safe removal of different foreign bodies by endoscopic approach. In this study we report a case of foreign body in the infratemporal fossa. The anatomic position of this region and the presence of important neurovascular structures make this region a sophisticated one. Commonly open procedures are used but have morbidity of neurovascular system. To prevent facial nerve injury in this case which is the most important factor for us, we decided to remove the foreign body under endoscopic guide by a temporal lift incision.
S. B. Pousti (&) F. Izadi N. Nikpour A. Shirali E.N.T Department & Ear, Nose, Throat, and Head & Neck Surgery Research Center, Hazrat Rasoul - Akram Hospital, Tehran University of Medical Sciences, Tehran, Iran e-mail: [email protected]
Case Presentation A 4-year-old girl living in Tehran was referred to the emergency department of Rasoul-akram hospital several hours after insertion of a shoemaker’s needle to her right temporal region. The patient was conscious and slightly agitated. She complained about the pain of the insertion point. She had no bleeding, hypoesthesia, or vision disturbances but the insertion point was slightly edematous. Cranial nerves examination was normal on both sides. Skull X-ray and face CT scan demonstrated a 0.3 9 4 cm metallic foreign body in the right infra temporal fossa (Figs. 1, 2, 3). It had entered the area from temporal region and passed below the zygomatic arch. Its proximal tip was several millimeters away from the skin and the distal tip was protracted to the pterygoid fossa. The patient was transferred to the operation room for removal of the foreign body. Under general anesthesia, a vertical incision was made 1 cm behind the entry site of the foreign body, parallel to the hair line. Efforts to remove the foreign body using blunt dissection were unsuccessful. The proximal tip of the foreign body seemed to be accessible by forceps but there was a possibility of neurovascular injury especially branches of the facial nerve were at risk during blunt dissection. Incision extension was not preferable due to inappropriate cosmetic results as the patient was a 4-year-old girl. Thus, we decided to use a combination of plastic s
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