Incidental Finding in Pre-Orthodontic Treatment Radiographs of an Aural Foreign Body: A Case Report.

Cinzia Maspero,Claudia Dolci,Maria Grazia Cagetti,Francesco Inchingolo,Gianluca Martino Tartaglia,Andrea Abate

doi:10.3390/children9030421

Abstract

The presence of foreign bodies in the external auditory canal of young patients may cause, if left untreated, severe permanent damage to the adjacent anatomical structures, and infections. A 10-year-old patient with an intellectual disability underwent orthodontic evaluation. An aural radiopaque finding was visible in the lateral cephalogram and in the orthopantomography. The patient’s mother reported that her son never showed any ear discomfort, except for a mild hearing impairment that was never investigated. The patient was referred to an ear, nose and throat (ENT) specialist that removed the foreign body located in the left external auditory meatus. The careful evaluation of dental radiographs, including pre-orthodontic and interim orthodontic radiographs, may help to identify silent incidental findings that may otherwise lead to severe complications if left untreated.

Highlights

Foreign bodies (FBs) inside the external auditory canal and in the nasal cavity are a common finding in pediatric patients
In the patient described in this paper, the long-standing foreign body was detected as an incidental finding in a pre-treatment lateral cephalogram prescribed for orthodontic evaluation and confirmed by the same finding in the patient’s panoramic radiograph
Pediatric dentists and orthodontists must pay particular attention to the evaluation in lateral cephalograms and panoramic radiographs of any suspicious findings and analyze all structures included in the image, since 75 percent of patients with ear foreign bodies are about eight years old or younger and may be, at least at first, asymptomatic

Summary

Introduction

Foreign bodies (FBs) inside the external auditory canal and in the nasal cavity are a common finding in pediatric patients. Council on Scientific Affairs and the U.S Food and Drug Administration recommend the first radiographic examination in pediatric patients to be taken after the first permanent tooth erupts (around 6–7 years) to assess growth and development [13] This age corresponds to the period of greatest discovery of foreign bodies in the external auditory canal. The frequency with which a clinician may detect incidental findings such as pathology and abnormalities in a patient needing orthodontic treatment is of particular interest to orthodontists, because in many cases they may require medical or odontological management [15]. The authors [14,15] reported a low percentage (0.16%) of cases of incidental findings of a foreign body, but they emphasized the importance for the orthodontist to carefully analyze the pre-orthodontic treatment radiographs from an orthodontic point of view. In the patient described in this paper, the long-standing foreign body was detected as an incidental finding in a pre-treatment lateral cephalogram prescribed for orthodontic evaluation and confirmed by the same finding in the patient’s panoramic radiograph

Case Report

Findings

3.3.Discussion

Conclusions