Qiam ud Din.
Foreign Bodies in Maxillofacial Region.
J Pak Dent Assoc Jan ;10(3):153-7.
Foreign bodies may be accidental, iatrogenic, or in more bizarre cases it may be deliberate a well. Five cases of foreign bodies reported here four were accidental but one was definitely deliberate. Two of the patients did not even know of having foreign body in their maxillofacial region. In such cases a thorough history of the patient is of utmost importance.
CASE-1: A young girt age 23 was referred to Khyber College of Dentistry by general medical practitioner who himself attempted right inferior alveolar block and in the process brokedown the needle. She developed diffuse pain on right side of the lower jaw as well as limited mouth opening. The patient was given local anesthesia upto the coronoid notch and within few minutes the patient was able to open her mouth. An intraoral incision was made over anterior border of the ascending ramus and blunt dissection disclosed the pterygomandibular space. The broken needle was approached at an angle perpendicular to its long axis with the help of examining probe and was recovered in short time. The wound was flushed with saline and was closed with 4/0 silk. The patient was reviewed ten days later for sutures removal. Her mouth opening was perfectly normal and there was no pain.
CASE-2: A 35 years young man visited my private practice complaining of disappearance of two metallic rods (about the size of the common pin) in his upper left jaw. He also complained of purulent discharge from his upper left jaw following the extraction of one of his molar tooth about three months back. On examination there was oroantral fistula in the upper left molar region from which pus was discharging into the mouth. The noseblowing test revealed that the socket is communicated with the antrum. P.N.S view showed two radiopaque rods like foreign bodies in the left antrum lying in the shape of X. It was interesting to listen to the patient story how it occurred. About four months back he went to a peripheral hospital for extraction of his upper left first molar tooth. The oroantral fistula occurred during the course of extraction. He was referred to the author for immediate repair but he did not report. A month later he felt salty taste in his mouth as well as purulent discharge but did not take any notice. After a while the marginal area around fistula use to itch off and on. The patient being a steel mechanic by profession made a small metallic rod about the length of the common pin for scratching the area with it. One day while he was scratching the area, the rod suddenly disappeared in the upper jaw. Instead of bothering about it, he made another metallic rod for the same purpose. It was when the second rod also disappeared in the upper jaw, he started worrying and reported for consultation. The patient was medicated for a week to make sure that the infection is under control. He was then operated under general anesthesia following routine investigation. The sinus was approached through residual oroantral fistula and the two metallic rods were recovered. The sinus was washed with saline and then repaired with buccal flap advancement. The patient was put on Velosef 500mg twice a day along with pain killer and Xynocine nasal spray. Ten days later the stitches were removed. The healing of the repair was uneventful.
CASE-3: A 9 years girl was referred to the author for feeling of lump in the left alar region following road traffic accident. On, extra oral examination there was slight tenderness in the left alar region but intra orally two different masses could be felt in the same region and were even more tender to palpation. The lateral soft tissue profile radiograph confirmed the presence of radioopaque masses in the left alar region. The patient was operated under general anesthesia following routine investigations and the alar region was approached through a sublabial incision. The radiopaque masses were removed with the help of plain dissecting forcep and they proved to be broken glass pieces. The area was irrigated and then closed with 4/0 silk sutures. A five day course of Amoxycillin 250 mg six hourly along with analgesic was advised. The sutures were removed after ten days.
CASE-4: A 28 years young police sub inspector came for restoration of his upper left broken central incisor tooth. On examination his upper lip was slightly swollen. He gave a history of fall on the ground during an exercise about two month`s back. As a result the tooth brokedown and caused injury/swelling of the upper lip. The swelling gradually subsided but the lip never came to its original size. Periapical x-ray revealed a radiopaque mass resembling the shape of the crown, superimposing the remaining part of the broken tooth. Lateral soft tissue profile radiograph confirmed the presence of radiopaque mass in the upper lip. This was removed under local anesthesia and proved to be broken part of the crown of upper left central incisor tooth. The patient was prescribed Amoxycillin 500 mg six hourly for a week with an analgesic. The patient made a complete recovery and the lip attained its normal size in three weeks time.
CASE-5: A young man age 27 years, was referred to Khyber College of Dentistry with history of recurrent swelling in right submandibular and submasseteric area. He related the swelling to his lower right wisdom tooth but even after removal of his wisdom tooth, the swelling occurred twice. On digging out the history, the patient revealed that about three years back he was hit by a bullet, which just bruised the right corner of the lower lip. He bleed from inside the mouth but then nothing happened and he forgot all about it. On extra oral examination he had fluctuant swelling in right submandibular region. Intra oral examination was difficult to carry out due to limited mouth opening, but the oral hygiene appeared quite satisfactory and the lower right wisdom tooth was missing. PA face confirmed the presence of bullet in the right cheek area. The abscess was drained extra orally with corrugated drain put in and the patient was put on Ampiclox 500 mg TDS, Abozole 400 mg BD plus Tab. Voren 50 mg TDS. The patient was seen again after 2 days, he was feeling much better, the drain was removed, as it was not draining any more. The patient was advised to continue with antibiotic for a week and another appointment was given for removal of the bullet. After routine investigation, the patient was admitted in Khyber College of Dentistry and the bullet was removed through an intra oral approach from the right masseteric region. The postoperative phase was uneventful and the patient made a complete recovery.
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