Special catch

10 Apr

Hi all,

Yesterday a 10yo boy presented to our ED after fishing with his friend, who managed to catch him, instead of the Barramundi, with the fish-hook up his nose. The hook was situated just below the cartilage of the nasal septum, in the columella. XRays showed only 1 spike which didn’t cross the midline. We aimed for retracting the hook with a topical anesthetic and Nitrous Oxide, which seemed to work quite well but the hook was firmly anchored in the nose and we were unable to retract the hook without distressing the boy. Eventually we involved the ENT doctor who injected Lignocaine/Adrenalin in the soft part under the septum, the area you can feel with two fingers on either side – the columella again. Approached from the unaffected side with a small needle, a small amount of anaesthetic was deposited in the centre causing diffusion up on either side of the septum. A small nick overlying the spike and preparation of the surrounding tissue off the spike while holding the hook under light tension with a needle driver released the hook from the nose without complications or any pain!




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