Case Report

Magnetically adherent nasal foreign bodies: a novel method of removal and case series^B

Abstract

The use of small, powerful magnets as body decoration is growing in popularity. Accidental adherence of these magnets to the nasal septum creates a mechanism for septal necrosis; removal of the magnets is difficult due to the strong adherent force they create across the septum. Nonferromagnetic tools greatly facilitate their removal. In this series, the author’s experience with 3 Adolescent patients with magnets tightly adherent to the nasal septum is described, along with a novel technique for removal of the magnets.

The growing popularity of small magnetic devices that simulate body piercings creates a unique mechanism for injury. This is a case series of 3 children who presented to suburban emergency departments (EDs) with magnets adherent to the nasal septum after abrupt removal of the exterior halves of the magnets or compression of the nares. The literature reports several complications related to the accidental dislodging and subsequent adherence or ingestion of these high-force magnets, including septal necrosis and perforation [1-3], and even intestinal perforations [2]. Pressure to the nasal septum with packing and/or septal hematoma is a well-known mechanism of septal necrosis. This article describes the difficulty and necessity of timely removal of ferromagnetic foreign bodies that are tightly adherent to both sides of the nasal septum.

In a span of 9 months, 3 children aged 9 to 12 years presented to a suburban ED with magnets adherent to the nasal septum. The mechanism of injury was consistent across the cases. First, the children placed them against the exterior nares bilaterally (Fig. 1). The septal adherence came when either the abrupt removal of the exterior pieces caused the internal pieces to snap to the septum, or direct contact (ie, pinching the nose) caused the internal pieces to adhere to the septum. In all cases, the patients presented to the ED within

^? No outside grants or funding are associated with this research.

2 hours of injury and were seen by the emergency physician within 4 hours of injury.

Removal of the foreign bodies in this series proved to be quite challenging. Multiple attempts by ED physicians using conventional tools under local anesthesia (with either cocaine or lidocaine and oxymetazalone) were unsuccess- ful. Bayonet forceps proved to lack the grip strength necessary to break the magnetic attraction without being pushed aside by the magnet’s force. A pair of curved hemostats was unable to adequately grip the magnets. A pacemaker magnet was not powerful enough to remove the magnets. After telephone consultation with an otolaryngol- ogist, a hook was fashioned with a nonferromagnetic blunt probe. Using the hook, the magnets were able to be removed from each other’s force and then easily came out of the nose. This method was then used in the second and third cases with good results. Ward and Selvaduari [4] describe magnetizing a wax hook to break the attraction; after doing so, the magnets are easily removed with conventional methods.

The nasal septum has a rich Blood supply, provided through branches of the facial artery. Kiesselbach’s plexus, a rich area of anastomoses, provides high blood flow to warm and moisten inhaled air. The cartilage underlying the plexus and composing the distal septum is quite vulnerable to ischemic insults caused by tamponade. These magnetic foreign bodies provide a novel mechanism of tamponade. Several cases have been reported of such foreign bodies managed in a nontimely fashion causing necrosis and perforation of the septum [1-4].

In summary, septally adherent magnetic foreign bodies create a condition with high potential for morbidity and likely will increase in frequency of presentation as this form of body decoration increases in popularity. These author describes experiences in their removal and suggests either polarized or nonferromagnetic tools be used to remove them. Regardless of method, prompt removal is necessary to avoid potentially significant morbidity.

Acknowledgment

The author would like to acknowledge the assistance of Marc L. Pollack, MD, PhD, and Amy Kusmiesz, MS, in the editing and submission process.

0735-6757/$ – see front matter (C) 2008

839.e2 Case Report

Fig. 1 An illustration of magnets placed in the nares bilaterally.

Ralph Daniel Bledsoe MD Section of Prehospital Care and Disaster Medicine York Hospital Emergency Medicine Residency Program

York, PA 17405, USA

Pennsylvania State University School of Medicine

Hershey, PA 17033, USA Drexel University College of Medicine

Philadelphia, PA, USA E-mail address: [email protected]

doi: 10.1016/j.ajem.2008.01.036

References

1. Lehman DA, Roy S. Septal perforation caused by nasal magnetic foreign bodies. Ear, Nose, and Throat J 2005;84(5):266-7.
2. McCormick S, Brennan P, Yassa J, Shawis R. Children and mini- magnets: an almost fatal attraction. Emerg Med J 2002;19:71-3.
3. Lancaster J, Mathews J, Sherman IW. Magnetic nasal foreign bodies. Injury 2000;31:123.
4. Ward VMM, Selvaduari D. A magnetic nasal attraction. J Accid Emerg Med 2000;17:53.