Indian Journal of Dental Research

SHORT COMMUNICATION
Year
: 2011  |  Volume : 22  |  Issue : 6  |  Page : 847--849

Multiple glass pieces in paranasal sinuses


Syed Ahmed Mohiuddin, Shazia Rahiman, Shammeem Sultana 
 Department of Oral and Maxillofacial Surgery, Al-Badar Dental College and Hospital, Gulbarga, Karnataka, India

Correspondence Address:
Syed Ahmed Mohiuddin
Department of Oral and Maxillofacial Surgery, Al-Badar Dental College and Hospital, Gulbarga, Karnataka
India

Abstract

Here, a case has been reported of a road traffic accident with multiple glass pieces arranged in an unusual pattern in the left maxillary sinus, ethmoid sinus, nasopharynx and medial side of the orbit, as seen in the radiographs. Combined surgical approach through the existing wound and endoscopic surgery was successfully used to remove nearly all the glass pieces.



How to cite this article:
Mohiuddin SA, Rahiman S, Sultana S. Multiple glass pieces in paranasal sinuses.Indian J Dent Res 2011;22:847-849


How to cite this URL:
Mohiuddin SA, Rahiman S, Sultana S. Multiple glass pieces in paranasal sinuses. Indian J Dent Res [serial online] 2011 [cited 2014 Oct 20 ];22:847-849
Available from: http://www.ijdr.in/text.asp?2011/22/6/847/94683


Full Text

Various foreign bodies like glass fragments, [1] metal, [2] bullet, wood splinters, bamboo, [3] piece of gauze and cotton, roots of teeth, endodontic instruments and materials and knife blades have been reported in the paranasal sinuses, with glass and metal fragments being the most common among them. [4]

Nearly 70% of such foreign bodies are due to penetrating injuries in the faciomaxillary region, [5] while the remaining are lodged following oral surgical procedures like extraction, surgical endodontics, antral surgeries, etc.

This article reports another unusual presentation of glass pieces and discusses the possible nature of injuries and usefulness of the intranasal endoscopic approach for the ethmoid and nasopharynx regions for successful removal of multiple glass pieces.

 Case Report



A 37-year-old male was referred to our hospital after primary care. He met with a road traffic accident (RTA) at midnight in which the patient was knocked down beside the road. Following the accident, there was a wound on the left side of the face. There was no history of loss of consciousness, vomiting and bleeding from the ears. He had epistaxis, which stopped spontaneously.

On examination, the patient was conscious, alert and oriented without neurological deficit. There was a lacerated, vertical wound on the lateral side of the nose of about 4 cm extending from the medial canthus up to the left alar base. There was an obvious ectropion of the left lower lid. There was no other wound or evidence of glass pieces externally. Eyeball movements were normal without loss of vision. Ophthalmologist consultation ruled out intraocular injuries.

A plain radiograph paranasal sinus showed evidence of multiple radiopaque foreign bodies seen in the left maxillary sinus arranged like a small spherical ball [Figure 1] and [Figure 2].{Figure 1}{Figure 2}

Computerized tomography (CT) of the paranasal sinuses and orbit confirmed fracture of the left maxillary anterior wall and roof with multiple high-density foreign bodies (glass pieces), with collection of fluid in the maxillary antrum, ethmoid sinus, medial side of the orbit (extraconal) nasal cavity and nasopharynx. The optic nerve and globe were normal [Figure 3].{Figure 3}

Multidisciplinary approach was planned to remove glass pieces endoscopically and to correct eye lid deformity at the same time. Multiple glass pieces were removed from the nose, ethmoids and nasopharynx by endoscopic sinus surgery. Maxillary sinus and orbital glass pieces were removed by exploring the previous wound [Figure 4]. Correction of medial canthus and ectropion was carried out simultaneously. Nearly 90 pieces of glass, measuring about 3-4 mm, regular in shape, were removed [Figure 5]. Postoperative radiographs confirmed complete removal of all glass pieces [Figure 6]. Immediate postoperative photograph showed not much of exploration and all glass pieces were removed from the same wound [Figure 7].{Figure 4}{Figure 5}{Figure 6}{Figure 7}

 Discussion



Foreign bodies in the paranasal sinuses are rare. Glass pieces, bullet, metal endodontic instruments and materials, etc. have been reported, but this type of radiological presentation of small, multiple glass pieces arranged regularly symmetrically, like a necklace, in the maxillary sinus is unusual.

The windscreen glasses, which are manufactured for motor cars, are mostly made up of synthetic polymers that, when broken, shrink and result in small multiple fragments. Following the RTA, a single piece of glass would have penetrated through the lacerated wound. Because of the impact with the left lateral wall of the nose, the glass might have shattered into multiple fragments, entering the left maxillary, ethmoid sinuses and medial side of the orbit, nose and nasopharynx. Otherwise, it would be practically impossible for 80-90 glass pieces to enter through a single lacerated wound and arrange themselves in that typical fashion as presented in radiographs.

Although standard plain radiographs clearly show the presence of foreign bodies, especially when they are of high density like glass or metal, their precise and accurate localization within the sinuses, orbits and soft tissue can only be obtained by CT scanning. [6]

Multiple small pieces of glass are difficult to remove and if left may result in chronic sinusitis and foreign body granuloma formation, secondary infections, osteomyelitis and sinus formation.

Transnasal endoscopic technique [5],[6] offers excellent visualization and easy removal of multiple foreign bodies, especially in areas of ethmoid and nasopharynx, where surgical removal would have caused more extensive tissue damage. Exploration of the maxillary sinus through the same wound has helped us in complete removal of glass pieces from the maxillary sinus and the orbit.

This case has been presented to highlight the unusual presentation of glass pieces in the maxillary antrum and the role of endoscopic sinus surgery to remove foreign bodies from a site that is difficult to approach surgically.

Interdisciplinary cooperation in the management of such cases can give an excellent result.

References

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