Ouch, the Thought Even Hurts

An unfortunate man had a medical history of chronic sinus infections. The infection was spreading through his body.

He had sinus surgery which included scraping away infected bone, etc. His recovery was slow, but some improvement was noted, and then he seemed to regress. An MRI (which was very painful) revealed a small metal object in the sinus cavity. The recovered metal object is shown in Photograph A.

Photograph A  Overall view (mag 20x) of object
 removed from sinus surgery patient.

A second surgery was performed, removing the metal object which was thought to have been broken from some of the surgical instruments. A thorough review of the instruments normally present on the surgical tray failed to reveal any object that could be responsible for the subject metal object. The object appeared to be a nozzle or diffuser that would diffuse or disperse liquids. Some of the instruments on the surgical tray are shown in Photograph B.

Photograph B  Typical instruments on sinus surgery
 tray.

The results of an examination in the scanning electron microscope (SEM) are shown in Photograph C.

Photograph C  Scanning electron micrograph
 (mag 20x) of sinus surgery debris.

A chemical analysis using energy dispersive spectroscopy (EDS) was performed. The EDS spectra is shown in below in Figure 1.

Figure 1

The results of the EDS analysis indicated that the object was probably an 18-8 (18% Chromium and 8% Nickel) stainless steel.

A review of the surgeon's orders to the man indicated that he should use, rather extensively, a Waterpik.

A review of Waterpiks presently available indicated that all Waterpiks had rubber tips. A typical Waterpik is shown in Photograph D.

Photograph D  Typical Waterpick with rubber
 diffuser tip.

It was determined that the metal object was most likely a part of an older Waterpik. Upon presentation of test results, the matter was resolved.

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