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Foreign body impaction in the palate: a commonly misdiagnosed condition despite multiple case reports.

Hashem, Ahmed; Brown, Joseph; Kirschner, Richard
Ohio State University Integrated Plastic Surgery Residency
2014-03-15

Presenter: Joseph Brown

Affidavit:
The resident involved with this paper was intimately involved with the original conception of the paper, took part in the literature review, and had a large hand in the analysis of its results as well as the development of its ultimate manuscript which is pending submission.

Director Name: Gregory Pearson M.D.

Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial

Background: Unawareness of a condition will lead to failure to recognize pathology and the potential for misdiagnosis. Avoiding misdiagnosis is essential for avoiding unwarranted treatment modalities or invasive testing. This case report and literature review was written with the hopes of increasing awareness of the potential diagnosis of foreign body impaction of the hard palate in the infant and toddler age group.
Methods: Previously published reports in the PubMed database of foreign body impaction of the hard palate in patients between birth and five years of age were reviewed. The intention was to identify commonalities that could be extrapolated to risk factors, which would assist in identifying an earlier accurate diagnosis.
Results: 36 papers dating back to 1966 were found. In these papers, 47 patients were reported as having been diagnosed with foreign body impaction. The age of presentation was between 3 and 36 months (mean of 13.3). 36 patients (76.5%) were initially diagnosed with a more serious pathology. The most common misdiagnosis was a palatal neoplasm followed by oronasal fistula/cleft palate.
Conclusions: Due to either to a low incidence or under-reporting, foreign body impaction of the hard palate seems like a rather rare condition that a physician may encounter once in a career. Failure to recognize this, however, can lead to unnecessary exposure to systemic therapy, radiation exposure, and even general anesthesia. Awareness of this condition will allow for an early, accurate diagnosis.

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