Septal perforation caused by nasal magnetic foreign bodies.

An 11-year-old boy was brought to the pediatric otolaryngology clinic after he had intentionally placed magnets in both nasal cavities 2 days earlier. The child's pediatrician and an emergency room physician had been unable to remove the magnets.

A full head and neck examination revealed that the metallic discs were firmly lodged on both sides of the septum just posterior to the heads of the inferior turbinates (figure 1). Findings on the remainder of the examination were unremarkable.

[FIGURE 1 OMITTED]

An attempt to remove the magnets under topical anesthesia proved to be futile. The next day, the child was taken to the operating room for endoscopic examination and removal. The magnets were extracted with straight biting forceps. During the procedure, a well-defined, complete, bilateral erosion of the mucoperichondrium was noted (figure 2, A). The presence of 1.7 cm of exposed cartilage was also noted bilaterally. In view of the perceived high risk of septal perforation, immediate repair was undertaken. Bilateral mucoperichondrial flaps were raised, and an AlloDerm graft was placed on the left side between the flap and the cartilage (figure 2, B). Doyle splints were then placed. The splints were removed on postoperative day 8, and the flaps were noted to be intact and granulating. A clean 2-mm perforation was seen 6 weeks postoperatively (figure 3).

[FIGURES 2-3 OMITTED]

Metallic foreign bodies have been found to cause septal perforations. Battery impaction in the nose has been described as a cause of septal perforation secondary to alkali burns and subsequent necrosis. (1,2) Pressure necrosis is not believed to have been a contributing factor in these cases.

Nasal magnets have been described in the literature for therapeutic use--for example, as splints following septoplasty (3) and as a means of removing other metal objects. (4) Ingestion of magnets has been implicated in perforation and fistulization of the small intestines secondary to the attraction of two or more magnets across the walls of separate intestinal segments, resulting in pressure necrosis. (5-8) Karkos et al recently reported a case of septal perforation resulting from nasal magnet impaction over the course of 6 months. (9)

The case of our patient illustrates the potential for an impacted nasal magnet to rapidly cause pressure necrosis of the septal mucoperichondrium. Such a circumstance necessitates timely recognition, removal, and possible surgical intervention to prevent a perforation and its sequelae.

References

(1.) Fernando P. Perforation of nasal septum due to button battery lodging in nose. Br Med J (Clin Res Ed) 1987;294(6574):742-3.

(2.) Tong MC, Van Hasselt CA, Woo JK. The hazards of button batteries in the nose. J Otolaryngol 1992;21:458-60.

(3.) Seltzer A R The use of magnets to maintain centralization of the nasal septum following submucous resection. J Natl Med Assoc 1968;60:210-12.

(4.) Douglas SA, Mirza S, Stafford FW. Magnetic removal of a nasal foreign body. Int J Pediatr Otorhinolaryngol 2002;62:165-7.

(5.) Cauchi JA, Shawls RN. Multiple magnet ingestion and gastrointestinal morbidity. Arch Dis Child 2002;87:539-40.

(6.) Honzumi M, Shigcmori C, Ito H, et al. An intestinal fistula in a 3-year-old child caused by the ingestion of magnets: Report of a case. Surg Today 1995;25:552-3.

(7.) Lee SK, Beck NS, Kim HH. Mischievous magnets: Unexpected health hazard in children. J Pediatr Surg 1996;31:1694-5.

(8.) McCormick S, Brennan P, Yassa J, Shawis R. Children and minimagnets: An almost fatal attraction. Emerg Med J 2002;19:71-3.

(9.) Karkos PD, Karagama YG, Manivasam A, El Badawey MR. Magnetic nasal foreign bodies: A result of fashion mania. Int J Pediatr Otorhinolaryngol 2003;67:1343-5.

From the Department of Otolaryngology-Head and Neck Surgery, University of Miami.