Foreign Body Impaction in the Pediatric Palate: A Case Report of a Frequently Misdiagnosed Condition

This case report aims to increase awareness about foreign body (FB) impaction in the pediatric palate. The significance of this clinical entity lies in the fact that it is frequently misdiagnosed as a palatal fistula or mass. Patients are therefore subjected to a variety of unnecessary investigations, for example, computed tomography scans and x-rays. In this case report, a 13-month-old boy was referred for a newly developed oronasal fistula. Clinical evaluation, however, correctly identified a FB impacted in the palatal vault. The FB (button cap) was successfully removed under general anesthesia with adequate airway control. No complications were observed. The diagnosis of FB impaction in the pediatric palate can be simple: The usual scenario is of a child less than 4 years of age, who is otherwise healthy, presenting with a sudden-onset palatal mass or fistula. Typically history of palatal pathology is lacking, and the patient has no associated feeding difficulty, nasal regurgitation, speech, or airway symptoms. Thus, we believe a palatal FB impaction should be included in the differentials whenever a patient of this age group presents with a sudden-onset palatal fistula or mass without history of the disorder and no associated relevant symptoms. Specifically, an isolated hard palate cleft or fistula that spares the velum in the absence of nasal regurgitation or feeding difficulties is suggestive.