Approach to a sewing needle in the parapharyngeal space: A case report

Objective@#To describe a unique situation of a sewing needle lodged in the parapharyngeal space and elucidate the problems encountered in its successful removal.@*Methods@#Design: Case Report. Setting: Tertiary Private Hospital. Patient: One.@*Result@#A 24-year-old male tailor accidentally swallowed a sewing needle that pierced the oropharyngeal wall and was wedged in the parapharyngeal space. After a thorough physical examination, 70 degree rod endoscopy, radiography and doppler ultrasonography and intraoperative C-arm X-ray for intraoperative localization and as a guide for extraction all yielded less than optimal guidance. Although an intra-oral approach was initially taken, the transcervical approach provided the best access. @*Conclusion@#Removal of a sharp foreign body in the parapharyngeal space should be considered a surgical emergency owing to its close proximity to vital structures and the potential for serious complications. Identifying the exact location may require a variety of imaging modalities, and foreign body extraction may entail multiple surgical approaches.

Sewing Needle Obturation of Root Canal: A Rare Case Report.

Discovery of a foreign object in the root canal is unusual and rare. Forceful lodgement or impaction of the foreign object in the pulp chamber or root canal is usually accidental. It is seen more often among children with habits of chewing and placing various objects in the oral cavity. Despite new advances and a large understanding about the root canal morphology, retrieval of foreign objects from the root canal is still a challenging procedure to the endodontists. Exposed pulp chamber due to trauma or tooth left open for drainage after root canal access opening are predisposing factors to foreign body lodgement. The impacted foreign objects in root canals may act as a source in causation of discomfort, pain, infection, and swelling. An attempt to retrieve any foreign body from the root canal may increase the chances of its further apical displacement and firm lodgement in the apical third of the root invariably risking the prognosis of the tooth involved. The present case report describes an inadvertently broken sewing needle in the root canal of the permanent maxillary left central incisor with periapical abscess and its successful retrieval by non-surgical orthograde endodontic treatment.

Sewing Needle in Breast Parenchyma.

A 38 year old woman presented with pain in her left breast for last 8 days. She had a history of fall in road 8 days back. She was investigated with X-ray, ECG but no abnormality found. She was treated symptomatically, but got no relief. When we examined the patient, a stiff cord like structure was found deep in the lower outer quadrant of the left breast parenchyma. In the same old X-ray, a long thin pointed foreign body was seen in parallel and superimposed on an underline rib. The breast was explored under local anesthesia; a swing needle was found and removed. Foreign body like sewing needle in breast tissue is an extremely uncommon clinical condition; proper clinical examination and correlation with investigation can clinch the diagnosis early.

Nasopharyngeal Foreign Bodies.

Nasopharyngeal foreign bodies are rare and are likely to be missed. A high index of suspicion is required for their diagnosis. While reporting three cases of nasopharyngeal foreign bodies, the problems in their diagnosis and management have been discussed.

Tuberculous Pericardial Effusion.

Tuberculous pericardial effusion is common in Afro-Asian countries. Since, the introduction of HIV infection, the incidence of tuberculous pericardial effusion has increased not only in Afro-Asian countries but also the world over. It presents with the usual features of tuberculous infection (low grade fever, loss of appetite, loss of weight) along with features of pericardial effusion (dyspnea, cough and enlarged heart). The salient features of pericardial effusion are low volume pulse or even pulsus paradoxus, raised jugular venous pressure Kussmaul’s sign, congestive hepatomegaly, ascites and edema over legs. In massive pericardial effusion, patient may go into cardiac tamponade when patient is breathless, restless with poor volume pulse (typical paradoxus), engorged neck veins, sinus tachycardia, fall in blood pressure. Urgent pericardial paracentesis is warranted to reverse the hemodynamic changes with improvement in symptoms and signs. Laboratory tests reveal raised absolute lymphocyte count, raised ESR, cardiomegaly on X-ray chest, low voltage and sinus tachycardia on ECG, Echo-free space seen between two pericardial layers on 2D-echo with heart floating in pericardial sac. Diagnostic pericardial paracentesis shows that pericardial fluid is lymphocytic exudate, with elevated ADA and IFN-g levels. Tubercle bacilli may be isolated on culture, guinea pig inoculation and nowadays by PCR technique. For management of tuberculous pericardial effusion, antituberculous treatment with four standard drugs is started. Pericardial paracentesis with needle or even open drainage is useful in relieving symptoms and rapid recovery. Adjunctive corticosteroids are useful for rapid recovery and for prevention of development of constrictive pericarditis.