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 Table of Contents  
CASE REPORT
Year : 2018  |  Volume : 8  |  Issue : 2  |  Page : 120-123

Unusual foreign body on the palate in childhood: An indicator of poor parental supervision


1 Department of Oral Maxillofacial Surgery, Delta State University Teaching Hospital, Oghara, Nigeria
2 Teem Clinic and Dental Centre, Ekpan-Warri, Delta State, Nigeria
3 Department of Periodontics, University of Benin, Benin City, Nigeria

Date of Web Publication31-Dec-2018

Correspondence Address:
Dr. Clement Chinedu Azodo
Room 21, 2nd Floor, Prof. A.O. Ejide Dental Complex, University of Benin Teaching Hospital, Benin City 300001
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmd.ijmd_15_18

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  Abstract 


Foreign objects reported intraorally are more common in the floor of the mouth, cheek, and Wharton's duct and rarely in the palate and they include nuts, coin, magnet, wooden stick, pins, screws, button, batteries, or parts of toys. Monodora myristica (Gaertn) popularly called African nutmeg or calabash nutmeg as a foreign body in the palate has been reported. The objective of this report was to present two cases of impacted similar foreign objects on the palate of a 21-day-old neonate and a 13-month-old baby and to sensitize parents and caregivers on the possible causes of poor feeding in babies and the need for routine oral inspection. The babies' routine sucking was disrupted and accompanied with irritation and excessive crying with the foreign bodies on the palate. This prompted the mothers to look into the babies' mouths. The impacted substance was hard, nontender, and nonpulsatile, measuring approximately 18 mm × 10 mm located close to the midline for the neonate and on the left alveolar ridge for the second baby. After dislodging the object, it was found to be the half shell of the nut Monodora myristica (Gaertn), popularly called African nutmeg or calabash nutmeg. The nut is used as a local spice in preparing pepper soup for mothers soon after delivery. Adequate childcare with relevant supervision by parents will obviously prevent the introduction of foreign objects into their children's mouths. A routine observation of the children's mouth by parents or caregivers could lead to the discovery of foreign bodies before they are transferred to the esophagus or airway with the associated complications.

Keywords: African nutmeg; foreign body; hard palate; neonate


How to cite this article:
Etetafia MO, Addisi R, Azodo CC. Unusual foreign body on the palate in childhood: An indicator of poor parental supervision. Indian J Multidiscip Dent 2018;8:120-3

How to cite this URL:
Etetafia MO, Addisi R, Azodo CC. Unusual foreign body on the palate in childhood: An indicator of poor parental supervision. Indian J Multidiscip Dent [serial online] 2018 [cited 2019 May 20];8:120-3. Available from: http://www.ijmdent.com/text.asp?2018/8/2/120/249113




  Introduction Top


The main entrance of foreign bodies into different parts of the body is the mouth. Children often play with their hands and introduce them and any other available objects into their mouths. This is characteristic of the oral stage of mental development in infants. Objects reportedly inserted into the mouth include nut, coin, magnet, wooden stick, pins, screws, button, batteries, and parts of toys.[1],[2],[3],[4] The reported intraoral location for foreign bodies include floor of the mouth, cheek, and Wharton's duct.[5],[6],[7],[8] The lodgment of foreign bodies in the palate though less common due to the firm palatal mucoperiosteum and the effect of gravity has been reported.[4]

Foreign bodies lodged within the mouth may have little or no immediate effect. However, some become symptomatic after a long period leading to local inflammation with resultant pain, gingival and/or oral mucosal bleeding and feeding, or masticatory disruptions. In view of the risk of aspiration of ingested foreign bodies, pain and bleeding causation, feeding disruption, and the risk of being misdiagnosed, this case series of a rare type of foreign body in the palate is presented. The purpose was to sensitize parents and caregivers on the possible causes of poor feeding in babies and the need for routine inspection of the mouth of children by parents and caregivers.


  Case Reports Top


Case 1

This 21-day-old female neonate was referred to the clinic by the obstetrician who was in charge of the baby's delivery. The baby was delivered full term with no congenital anomaly. There were no systemic problems after the delivery and baby was breast fed soon after delivery. The baby is the second child in a monogamous setting. The older child is 3 years old and has always expressed interest in feeding the neonate. The presenting complaint was excessive crying and difficulty in sucking the breast milk for about 5 days. The mother inspected the mouth of the neonate and found a dark brown substance within the palate. General and systemic examination revealed no anomaly. Intraorally, the mouth opening was good, the upper and lower arches do not have erupted teeth as expected. There was no abnormality associated with the oral mucosa except that there was an oval-dark-brown lesion close to the midline of the palate located diagonally from the right to the left sides with a clear demarcation from the surrounding mucosa which was slightly erythematous and with whitish coating. [Figure 1] shows the intraoral appearance of foreign body lodged in the palate of a neonate. Palpation revealed a hard nontender, nonpulsatile swelling measuring approximately 18 mm × 10 mm. An initial diagnosis of osteomyelitis was made with differential diagnosis of foreign body, congenital lipoma, and eosinophilic granuloma. Occipitomental radiograph of the skull did not reveal any bone pathology and this gave a support for a foreign body. The baby was prepared for the removal of foreign body under light sedation. In the theater, the substance was dislodged from the palatal rugae with little effort using a closed artery clip inserted between the edge of the foreign body and the mucosa. A close examination of the dislodged foreign body revealed it to be the half part of the shell of a commonly used nut, local spice, Monodora myristica (Gaertn), popularly called African nutmeg or calabash nutmeg. In Nigeria, the local names include ariwo, ehuru, ehu, awerewa, gujiya dan miya, and erhe. This nut is a common food spice used for women soon after delivery and up to 3 months after the delivery. It is said to contain antioxidant with anti-inflammatory properties. The dislodged foreign body is shown in [Figure 2]. The inner part is shown in [Figure 3]. The baby's palatal mucosa [Figure 4] after the dislodgment showed an impression of the outline of the edge of the foreign body. The mother confirmed the use of that spice to prepare food a few days before the incidence. The baby was discharged home on the same day, and the palate healed uneventfully over 1 week.
Figure 1: Foreign body located on the palate

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Figure 2: Outer part of the half-shell

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Figure 3: Inner part of the half-shell

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Figure 4: Palatal mucosa after the removal

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Case 2

A 13-month-old baby was referred by a general medical practitioner who reviewed the baby following a complaint of irritation and unusual refusal to feed. Extraoral examination showed a healthy looking baby with no obvious respiratory distress. Intraorally, the upper and lower arches contained no erupted teeth. Located on the left upper alveolar ridge was a dark object covering the location of about two unerupted deciduous teeth [Figure 5] With the previous case of an impacted foreign object in the palate, the diagnosis was not a challenge. The object was removed with the patient on the arms of the mother on a well-lit dental chair. A close look at the object [Figure 6] and [Figure 7] showed the half shell of the similar nut Monodora myristica (African nutmeg). The impression of the object on the palatal mucosa is shown in [Figure 8] with inflammation of the affected mucosa. The patient was discharged home with analgesics and antibiotics.
Figure 5: Foreign body on alveolar mucosa

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Figure 6: Inner part of the shell

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Figure 7: Outer part of the shell

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Figure 8: Inflamed mucosa after removal

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  Discussion Top


The foreign object in this case series was the half-shell of the nut Monodora myristica, a local spice used in preparing food for nursing mothers. The diagnosis in the first case was initially thought to be a bone pathology but after the radiograph and further enquiry from the mother foreign body became the main diagnosis before the baby was taken to the theater. The second case posed no diagnostic challenge due to the similar presentation of the first case. The source of this palatally impacted foreign body in the neonate is not well established, but there is the possibility of its introduction by the older sibling within the same vicinity.

Parents of the children seek medical attention when their children were seen to have ingested a foreign body or there is the presence of signs and symptoms related to foreign body ingestion or inhalation. At other times, the child stool may be discovered to contain a foreign body. In our case, being a neonate, the child exhibited symptoms of excessive crying and discomfort during the breast feeding which after a few days prompted the mother to look into the mouth. The main source of introduction of this impacted foreign body is not established, as this child is mentally too young to be able to introduce such an object into the mouth. However, with an older sibling present in the same house, there is a possibility of playful feeding of the neonate leading to intraoral foreign body lodgment. This, the authors considered an indicator of poor parental supervision. On the other hand, the older child could be seeking attention or manifesting a form of psychological abnormalities. The time laps before the discovery of the foreign body is worth noting and could be attributed to low likelihood of mothers or caregivers in the environment to routinely examine their child's mouth. While on the palate, the mother's breast nipple could have dislodged it into the airway or the esophagus with the associated complications.

Foreign bodies embedded in the palate of children can occasionally mimic other types of oral cavity pathology[9] that is the main reason why it has become very important to include it as one of the differentials of palatal pathology. The nature of foreign bodies seen among children varies from coins and nuts to batteries but the nature of the one presented here has not been reported before in the literature. The age of our patient is among the youngest of the patients with foreign bodies impacted on the palate. In the report[1] of seven cases with palatal foreign bodies, the age range was from 3 to 18 months, while the age range in other reports[10],[11] were 7–11 months.

Parents and caregivers of children should ensure that the contact between older and younger children, especially newborns should be under appropriate supervision. Proper disposal of waste after eating is also deemed essential to prevent this usual foreign body impaction in the palate of children.


  Conclusion Top


Adequate childcare with relevant supervision by parents will obviously prevent the introduction of foreign objects into their children's mouths. A routine observation of the children's mouth by parents or caregivers could lead to the discovery of foreign bodies before they are transferred to the esophagus or airway with the associated complications.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
de Jong AL, Moola F, Kramer D, Forte V. Foreign bodies of the hard palate. Int J Pediatr Otorhinolaryngol 1998;43:27-31.  Back to cited text no. 1
    
2.
Conners GP, Chamberlain JM, Weiner PR. Pediatric coin ingestion: A home-based survey. Am J Emerg Med 1995;13:638-40.  Back to cited text no. 2
    
3.
Vijaysadan V, Perez M, Kuo D. Revisiting swallowed troubles: Intestinal complications caused by two magnets – A case report, review and proposed revision to the algorithm for the management of foreign body ingestion. J Am Board Fam Med 2006;19:511-6.  Back to cited text no. 3
    
4.
Ondik MP, Daw JL. Unusual foreign body of the hard palate in an infant. J Pediatr 2004;144:550.  Back to cited text no. 4
    
5.
Shehata E, Moussa K, Al-Gorashi A. A foreign body in the floor of the mouth. Saudi Dent J 2010;22:141-3.  Back to cited text no. 5
    
6.
Aregbesola SB, Ugboko VI. Unusual foreign bodies in the orofacial soft tissue spaces: A report of three cases. Niger J Clin Pract 2013;16:381-5.  Back to cited text no. 6
[PUBMED]  [Full text]  
7.
Auluck A, Behanan AG, Pai KM, Shetty C. Recurrent sinus of the cheek due to a retained foreign body: Report of an unusual case. Br Dent J 2005;198:337-9.  Back to cited text no. 7
    
8.
Chowdhary A, Kalsotra P, Parihar SS, Bhagat DR, Ali N, Rashid A. Foreign body in the Wharton's Duct. JK Sci 2005;7:61-2.  Back to cited text no. 8
    
9.
Rocha AC, Bernabé DG, Amato Filho G, Guimarães Júnior J, Machado GG. Foreign body in the hard palate of children and risk of misdiagnosis: Report of 3 cases. J Oral Maxillofac Surg 2009;67:899-902.  Back to cited text no. 9
    
10.
Khan NI, Khan AA. Palatal foreign body in an infant-A very rare occurrence and a differential diagnosis in palatal lesions. Ann Hamdard Univ 2011;2:32-3.  Back to cited text no. 10
    
11.
Eshete M, Abate F, Hailu T, Gessesse M, Butali A. Foreign bodies simulating a congenital palatal fistula and vascular anomaly. Case Rep Dent 2015;2015:387092. doi: 10.1155/2015/387092.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]



 

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