Removal of a BB from the Nasofrontal Outflow Tract Using a Urologic Basket

Abstract

Objectives: 1) Describe a novel approach to BB removal from the nasofrontal outflow tract. 2) Present pre-, intra-, and post-operative photographs and imaging to illustrate surgical technique. 3) Review other techniques described for similar foreign bodies. Methods: Case report of patient receiving treatment in November 2012. The patient presented with a history of BB trauma to the forehead eight months prior. Imaging revealed a BB lodged in the right nasofrontal outflow tract. Symptoms reported since the trauma included headache and facial pain. Results: This case resulted in successful removal of the BB using a Lynch incision approach and retrieval of the BB with a urologic basket device. The incision was made through the scar that resulted from the initial trauma. The frontal sinus was entered using a standard otologic drill. The BB was noted to be lodged in the nasofrontal outflow tract. A urologic basket was used to grasp the BB and remove it from the tract. This resulted in removal with minimal tissue trauma. The patient reported improvement in symptoms following the procedure. Conclusions: There are several case reports in the literature involving endoscopic or external approaches to foreign body removal within the frontal sinus. In these cases standard instruments such as hemostats were used for retrieval. The location within the nasofrontal outflow tract is unique and emphasizes the importance of removal with minimal tissue trauma to prevent stenosis. This case illustrates an opportunity to use seemingly unrelated surgical equipment to accomplish impacted foreign body removal with minimal trauma to surrounding tissues.