Vishalini K, Deepthi Angeline, Ranjitha Gracelin, Deepak John Hearty
Department of Oral Medicine and Radiology, Rajas Dental College and Hospital, Kavalkinaru Jn, Tirunelveli.
Running title – Embedded foreign body particles in the face
Received: 9-09-2023
Revised: 18-09-2023
Accepted: 27-09-2023
Address for correspondence: Dr. Vishalini K MDS, Post Graduate, Department of Oral Medicine and Radiology, Rajas Dental College and Hospital, Kavalkinaru Jn, Tirunelveli
Address: 280/1B, Main road, Anna nagar, Pallapatti, Aravakurichi (Tk), Karur – 639205
E-mail – vishalinikalaivanan98@gmail.com
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How to cite this article: Vishalini K, Deepthi A, Ranjitha G, Deepak J H. Multiple Embedded Foreign Body Particles – A Case Report and Review of Literature. J Oral Biomed Sci 2023; 2:
ABSTRACT
Penetrating injuries to the maxillofacial region are highly frequent. An oral and maxillofacial surgeon faces a challenge when these injuries result in foreign bodies embedded deeply in the maxillofacial region. These objects have the potential to cause significant discomfort and infection. Magnetic resonance imaging, computed tomographic scans, plain radiographs, and ultrasonography can all be used to diagnose these foreign bodies early. These foreign bodies ought to be removed after being identified and located. Here, we present one such rare case of 38 years old male with multiple foreign bodies in the face region.
INTRODUCTION
CASE PRESENTATION
A 38 year old male patient reported to the outpatient department with a chief complaint of decayed tooth in the upper left back tooth region for past 6 months & also complaints of discomfort in the lower front tooth region for past 5 months. On revealing the presenting illness patients gave a history of food lodgment and no history of pain and sensitivity. Patient gave a history of gunshot splash injury before 5 months and he was hospitalized & underwent eye and ear surgery during that time. Patient gave a history of removal of some of the gun particles before 1 month.
Medical history of the patient revealed that he has been diagnosed as diabetic before 1 month and he was under regular medication for past 1 month. Patient had undergone eye prosthesis in the left side of eye before 1 week. Dental history revealed patient had undergone root canal treatment before 8 years. Family history revealed that patients mother had hypothyroidism and was under regular medication. General examination and vital signs of the patients appears to be normal.
On extraoral examination eye prosthesis was seen in the left side of the eye and the scar was seen behind the left side of the ear. On intraoral examination no abnormalities was seen in the soft tissue regions. Extrinsic stains and supragingival calculus was seen. Dental caries was present in relation to 15, 27,37,38,47,48 and root stumps in relation to 24. Mild regressive alterations (Attrition) were noticed in upper & lower anteriors and abrasion was noticed in relation to 16. As per the patients complaint of discomfort in the lower front tooth region and history of gun shot splash injury provided by the patient, we took radiographs solely for investigative purpose.
RADIOGRAPHIC FEATURES:
Orthopantomography (OPG) revealed multiple small radiopaque structure was seen scatterly over the entire radiograph. Numerous radiopacities was seen scattered in the root canal region of 24, hard palate, nasal septum, left coronoid process, left mental foramen region, and right body of mandible (Figure 1).
Figure 1: Orthopantomogram showing multiple radiopaque foreign bodies
CBCT revealed that hyperdense material seen in the middle of nasal septum and just above the hard palate which measured about 4.2 x 4.8 mm in size (Figure 2). Hyperdense particle seen in the buccal aspect of 25 which measures about 5.8 x 3.1 mm in size (Figure 3). Another one hyperdense material was present in the exit of left side of mental foramen which measures 3.9 x 4 mm in size (Figure 4). Two hyperdense particles was seen in the left side of chin region which measures 6.2 x 3.4 mm and 5.7 x 3.4 mm in size respectively (Figure 5). Another two hyperdense particles seen in the lower aspect of hyoid bone and behind the right side of hyoid bone which measures about 3.9 x3.9 mm and 4.1 x 4 mm in size respectively (Figure 6). Almost all the hyperdense materials having the average Hounsefield units of 15383 HU.
On correlating the history, clinical examination and radiographic features the provisional diagnosis was given as multiple foreign bodies.
Figure 2: CBCT showing hyperdense foreign body in the middle of nasal septum and just above the hard palate
Figure 3: CBCT showing hyperdense foreign body in the buccal aspect of 25
Figure 4: CBCT showing hyperdense foreign body in the exit of left side of mental foramen
Figure 5: CBCT showing two hyperdense foreign bodies in the chin region
Figure 6: CBCT showing hyperdense foreign bodies in the lower aspect of hyoid bone
DISCUSSION
Foreign body penetration is one of the common entities in the oral and maxillofacial region. It can occur as a sequelae of trauma or therapeutic interventions. Some of the etiologies are motor vehicle accidents, assaults, bullet injuries and iatrogenic dental injuries [1]. Foreign bodies are usually forced into the bone, surrounding soft tissues, antral cavity and occasionally fragments are displaced into the respiratory tract. Foreign bodies can be located in different localizations in the maxillofacial region. Foreign bodies on panoramic radiography varies within the range of 0.3–2.8% in the literature [3].
In dentistry different kinds of foreign bodies can be penetrated into the oral cavity during treatment. Some of them are filling materials like amalgam particles & endodontic instruments, orthodontic brackets, fractured hypodermic needles, fractured instruments and certain self-injuries like staples and shrapnel penetration [3].
Acute and possibly fatal consequences from foreign body injuries include bleeding, airway compromise, neurovascular injury, pseudoaneurysm and paresthesia in the inferior alveolar nerve. Even though some retained foreign bodies may not cause any symptoms for years or even forever, there is always a chance of late sequelae, mostly from infections, which can cause permanent impairment. Prolonged pain, poor wound healing, inflammatory reactions with possible abscess formation, fistulas, necrotizing fasciitis, and foreign object migration are examples of delayed complications [2-5].
Imaging studies can significantly raise the chance of detecting a foreign body. By accurately identifying the foreign object’s anatomical location and its spatial relationship to nearby structures, they can also help with surgical planning by lowering the possibility of collateral damage. The identification of foreign objects can be done using computed tomography (CT), magnetic resonance imaging (MRI), ultrasound, and plain radiography. Choosing the ideal modality mainly depends on the chemical composition of the suspected foreign object and on its assumed anatomical location. Skilled radiologists and radiographers who are experienced in imaging the features of foreign bodies also contribute to successful detection [6-9].
Treating and approaching the foreign body involves a multidisciplinary team approach and the proper sequencing of the treatment should be done. These foreign bodies must be removed to prevent further complications. In asymptomatic cases, according to location and the characteristic of the foreign body, it can be kept under constant observation and proper follow- up should be done to avoid complications [10,11].
Conflict of interest: None
Source of support: Nil
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