The respiratory tract and esophagus of children are common sites for lodgment of foreign body. A foreign body in the soft tissue of the neck retained for a prolonged period is rare.

A five-year-old boy was seen in our hospital in August 1999 with a history of painless swelling over the right upper cervical region progressively increasing in size for eighteen months with rapid growth for six months. He did not have any fever, weight loss, night sweats or anorexia. He had reportedly fallen from a bicyle with a tooth-brush in his mouth before onset of this swelling. There were no external signs of injury. The head of the toothbrush had reportedly broken off and could not be traced. A physician elsewhere biopsied the swelling sixteen months after the onset and diagnosed chronic nonspecific cervical lymphadenitis. He was referred here as the swelling progressively increased in size.

On examination, he had a large nodular firm non-tender indurated swelling of 9x5cm size over the right upper cervical region with sprouting granulation tissue in the center. He had a right-sided partial lower motor neuron facial nerve palsy probably secondary to division of the facial nerve branch during the biopsy. There was no significant lymphadeno-pathy. His weight and height corresponded to the fiftieth percentile for age. Systemic exami-nation did not reveal any other abnormality. Plain X-ray of soft tissue neck showed a foreign body in the right upper cervical region (Fig. 1) which was suggestive of a tootbrush head. Surgical extraction confirmed the diagnosis. The tooth brush head was deeply embedded in the abscess cavity which probably entered the neck through the external injury. He was asymptomatic at discharge.

Post traumatic retention of foreign body in the soft tissue of neck is very rare. Thrombosis of the internal carotid artery may result form blunt trauma due to a fall with a pencil or popsicle stick in the child’s mouth(1). In the case reported by Recelli et al. a plastic pen cap penetrated through the anterior oral floor and submandibular gland(2). Janicke et al. reported long term retention of wooden pieces in the retromaxillary space in a child(3). Retained foreign bodies in the neck can present with torticollis in children(4).

In our patient, the presence of the foreign body in the neck had gone unnoticed for eighteen months as there was no associated pain, discomfort, dyspnea or dysphagia with the swelling. The parents missed the signi-ficance of the history of injury and the missing head of the toothbrush. Ultrasound done elsewhere was not able to visualize the foreign body while a plain X-ray taken in this hospital detected it.

In summary, we report a case of a broken head of a tootbrush lodged in the soft tissue of the neck of a child following penetrative injury during an accidental fall. This case illustrates the need for adequate history taking, clinical examination and radiological imaging to demonstrate the exact location of the foreign body so as to avoid unnecessary invasive procedures and parental anxiety.

J. Ebor Jacob
Chellam Kirubakaran, Jacob Chacko,*
Departments of Child Health and *Pediatric Surgery,
Christian Medical College Hospital,
Vellore, 632 004, Tamil Nadu, India.
E-mail: [email protected]