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354.e2 Foreign Body, Oral

Foreign Body, Oral Client Education
Sheet
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BASIC INFORMATION
mandible (short segment of large-diameter
bone) • Oral exam: general anesthesia usually neces-
sary (see Acute General Treatment below)
Definition ○ Burs stuck in lingual, palatine, gingival • Fine-needle aspiration of facial swelling
Foreign object lodged or embedded in the oral mucosa ○ Cytologic exam to confirm inflammation
cavity or pharynx ○ String foreign body around base of tongue; +/− infection
especially in cats ○ Microbiologic culture and sensitivity
Epidemiology ○ Grass awn in tonsillar crypt testing (aerobic and anaerobic)
SPECIES, AGE, SEX ○ Porcupine quills in and around muzzle • Ultrasound exam
Dog and cat, either sex, potentially more of a and oral cavity ○ Exophthalmos
problem in younger animals ○ Needle penetrating oral mucosa or visible ○ Facial swelling (abscess vs. neoplasia)
thread from needle that completely
RISK FACTORS penetrates oral mucosa Advanced or Confirmatory Testing
• Habit of chewing on foreign objects: bones, ○ Granulomatous lesions or draining tracts • Histopathologic exam of biopsied oral mass
sticks, string, sewing needles in oral cavity or oropharynx ○ Foreign body granuloma versus neoplasia
• Longer-haired dogs playing or running in • Penetrating oral injury, possibly associated • CT or MRI (p. 1132)
grassy/wooded areas with external facial swelling ○ Extent of abscess/granulomas
• Interacting with a porcupine • Findings associated with gastrointestinal ○ Identification and location of foreign
linear foreign body: abdominal palpation, bodies (metal, petrified wooden foreign
GEOGRAPHY AND SEASONALITY pain, plicated intestines bodies)
Grass awn foreign bodies are common, predomi-
nantly in the western United States. More likely Etiology and Pathophysiology TREATMENT
to encounter in spring and summer (p. 398) • Foreign body penetration of the oral cavity
may result in abscess formation in the Treatment Overview
ASSOCIATED DISORDERS surrounding tissues (most commonly ret- Removal of the foreign body can involve direct
• Oral granulomas robulbar or submandibular/intermandibular extraction from the oral cavity or surgical
• Retrobulbar abscess and oropharynx). exploration of an identified abscess. Associ-
• Submandibular/intermandibular abscess • Foreign body lodged between the maxil- ated inflammation, abscess formation, and/or
• Necrosis of intraoral structures lary premolars/molars can cause necrosis cellulitis are treated by surgical exploration,
• Linear foreign body causing gastrointestinal of the underlying palatine mucosa and debridement, and medical management. If
obstruction palatine bone and development of oronasal a linear foreign body is found, appropriate
• Cutaneous draining tracts: cervical, fistula. surgical intervention of the gastrointestinal
intermandibular • Burs embedded in the oral mucosa may incite tract is indicated (p. 353).
granulomatous reaction.
Clinical Presentation ○ Focal: mass Acute General Treatment
HISTORY, CHIEF COMPLAINT ○ Diffuse: across the whole surface of the After induction of general anesthesia:
• At-risk activities, such as tongue • Oral exam
○ Dog playing or running in grassy or • Linear foreign bodies caught around the base ○ Routine (foreign material may be found
wooded area of the tongue can become embedded into incidentally)
○ Dog seen interacting with porcupine the glossal soft tissue, making identification ○ Because exam could not be performed
○ Animal seen chewing on foreign object difficult. in awake patient (e.g., pain, fractious
• Signs of oral discomfort (e.g., pawing at ○ Can cause a significant inflammatory/ behavior, physical obstruction)
mouth, face rubbing, reluctance to eat hard granulomatous reaction • Radiographs
food, pain when opening mouth) ○ Radiopaque foreign body
• Facial or cervical swelling: exophthalmos, DIAGNOSIS ○ Soft-tissue swelling (abscess)
strabismus possible ○ Destruction of underlying bone
• Nonspecific signs: depression, anorexia, Diagnostic Overview • Removal of foreign body from oral cavity:
vomiting The diagnosis is suspected based on patient ○ Porcupine quills: grasp at base (nearest to
signalment, presenting history, and physical skin) with forceps, and extract gently.
PHYSICAL EXAM FINDINGS (including oral) exam findings. Thorough ○ Bone or stick: if tightly wedged, may be
• Nonspecific findings: depression, fever, oral exam may have to be performed under easier to remove by cutting (e.g., with
dehydration general anesthesia because of pain. Confirma- Stryker saw) first
• Reluctance to open/discomfort on opening tion requires identification of an intraoral ○ Release linear foreign body caught
mouth foreign body. around base of tongue. Attach metallic
• Facial swelling staple to string for monitoring passage
○ Exophthalmos Differential Diagnosis radiographically if surgery or endoscopy
○ Strabismus • Oral mass: neoplasia is not possible.
○ Submandibular/intermandibular swelling • Dental disease • Burs embedded in oral mucosa
• Halitosis • Facial/pharyngeal swelling: neoplasia or ○ Surgical debridement to remove plant
• Ptyalism salivary mucocele material and chronic granulomatous
• Oral discharge (hemorrhagic, purulent) lesions. Open wounds will be covered
• Findings related to the foreign body Initial Database rapidly by proliferating mucosa.
○ Bone or stick lodged across hard palate, • CBC: neutrophilia associated with inflam- • Surgical exploration, debridement, and lavage
between premolars/molars, or encircling mation or infection of abscess pocket(s)

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