Unusual foreign body presenting as a palatal tumor: case report.

This report describes an infant who presented with a half shell of a pistachio nut adherent to the palatal mucosa. Initial clinical examination suggested the possibility of a palatal tumor. The case is presented so that others are made aware of this phenomemon and potential hazard. Insertion of foreign particulate matter and objects into the mouth is an everyday occurrence with infants and children. Fortunately most are not aspirated nor of sufficient toxicity to cause serious harm. For example, McDonald and Avery (1987) reported that electrical burns to the mouth occur most frequently in children between 6 months and 3 years of age, due to insertion of, or chewing on live electrical wires. Recently, in a letter to the editor of the American Journal of Diseases of Children, Sussman (1986) presented a report of an infant who had ingested the half shell of a pistachio nut. The shell had become lodged on the palate and appeared as a tumor. Sussman was attempting to alert the medical community of this unusual presentation. A similar case presented at our institution for evaluation and treatment. Case Report A 9-month-old black female was brought by her parents to the School of Dentistry at Temple University. They had discovered a raised hard mass on the infant's palate. A raised flesh-colored mass could be seen easily on the palate (Fig 1). Digital palpation revealed the mass to be bony hard. A radiograph was obtained was but was noncontributory. The clinical differential diagnosis included a benign bony growth such as a torus or osteoma, and a possible malignancy such as an osteosarcoma or a chondrosarcoma. The possibility of an odontogenic tumor or a hamartoma also was considered. The infant was admitted to St. Christopher's Hospital for Children for evaluation and removal of the mass. Physical examination and past medical history were unremarkable. The oral surgeon then was able to disFIG 1 (left). A pistachio nut shell lodged in the palatal vault. FIG 2 (right). Appearance of shell following removal. 226 UNUSUAL FOREIGN BODY PRESENTING AS A PALATAL TUMOR: O'Brien et al.