ANESTHETIC MANAGEMENT OF PATIENT WITH FOREIGN BODY IN

RIGHT NASAL CAVITY WITH CONGENITAL MUSCULAR TORTICOLLIS

POSTED FOR FOREIGN BODY REMOVAL

Dr.P.Vimala Devi,Postgraduate,
Dr. Uma (Professor ), Dr.Srinivas (Asistant professor)
Govt ENT hospital,Osmania Medical College,hyderabad

BACKGROUND & AIM:

Nasal foreign bodies are seen in the Emergency Department mostly in pediatric
population. They can cause mucosal damage, bleeding, infection, aspiration depending
on the foreign body object.

Congenital torticollis - Incidence - 0.3% to1.9%.

Most common form - Congenital muscular torticollis.
Detected at birth or first few weeks of life.
Etiology: Intrauterine deformation, oligohydromios, uterine compression syndrome,
trauma, positional deformation, vertebral anomalies, unilateral atlantooccipital fusion,
Klippel Feil syndrome, unilateral abscence of sternocleidomastoid.

We aim to present a case of successful management of Congenital muscular torticollis

with fixed neck deformity posted for removal of foreign body right nasal cavity.
 ANESTHETIC MANAGEMENT OF PATIENT WITH FOREIGN BODY IN

RIGHT NASAL CAVITY WITH CONGENITAL MUSCULAR TORTICOLLIS

POSTED FOR FOREIGN BODY REMOVAL

CASE REPORT:
A 3 year old female child weighing 12kg
(Birth history: 2nd DCDA twin delivered by LSCS) with congenital torticollis.
Admitted for Right nasal cavity foreign body removal under general anesthesia.
Pre anesthetic evaluation:
History of foul smelling nasal discharge right nasal cavity since 3days.
Airway examination: Head tilted to left, chin to right, neck movements restricted with lateral fixed neck flexion on
left side, mouth opening restricted, MPG grade 2, SCM left side contracture present..
Afebrile, HR-114bpm, RR-22/min, SpO2 at room air-99%, no cardiac murmurs, lungs-clear.
 ANESTHETIC MANAGEMENT OF PATIENT WITH FOREIGN BODY IN RIGHT NASAL CAVITY

WITH CONGENITAL MUSCULAR TORTICOLLIS POSTED FOR FOREIGN BODY REMOVAL

MANAGEMENT:
After obtaining consent for GA and its associated complications, NBM
confirmation, child is shifted to OT. Resuscitation and difficult airway
management trolley were kept by side, and the equipment for tracheostomy was
made available.
Standard ASA monitors were connected. Position of child was supine, with head
ring placed, head rotated to left.
A smooth mask induction with sevoflurane in oxygen and nitrous oxide was done,
22G IV cannula on left hand secured.
Child was premedicated with Inj.Glycopyrrolate 10 mcg/kg iv, Inj.Ondansetron
0.1 mg/kg iv, Inj Fentanyl 2 mcg/kg IV. Inj .Propofol 2.5mg/kg iv was given. Inj
scoline 1 mg/kg iv given, under direct laryngoscopic visualisation, 4.5mm
uncuffed ETT was passed between vocal cords, fixed at 13cm depth. Throat pack
secured. Maintained with sevoflurane 2% in oxygen and nitrous oxide 50-50
ratio. Foreign body (sponge piece) was identified and removed using nasal
endoscope. Intraop period was uneventful and post procedure throat pack
removed. Child was extubated with stable vitals and shifted out of operation
theatre.
DISCUSSION:
We opted for General anesthesia because the child was uncooperative and very apprehensive. Troublesome
bleeding is anticipated. Foriegn body was posteriorly placed with risk of pushing back it back into nasopharynx and
foreign body is strongly suspected but couldnot be seen in anterior rhinoscopy .
CONCLUSION:
For foreign body nasal cavity, there might be chances of aspiration into trachea due to crying or reduction of muscle
tone so special attention is needed for safe airway management throughout the procedure. General anesthesia is
acceptable. Appropriate pre anesthetic evaluation for a child with torticollis with fixed neck deformity should be
done for other congenital anomalies and other syndromes