Rare Earth Metal Magnets: An Unusual Airway Foreign Body

From 2002 to 2011, over 15 000 cases of ingested magnets were estimated in the United States with the majority of cases occurring in 2007 or later. ¹ While most magnetic foreign bodies (FBs) involve the gastrointestinal tract, they can involve the upper aerodigestive tract necessitating urgent otolaryngologic care. ² Ingestion of more than 1 magnet poses a high risk of tissue injury due to the magnetic forces trapping mucosa with the possibility of causing erosions and perforations along the aerodigestive tract. We report a 12-year-old female who ingested a pair of rare earth metal magnets leading to dysphagia and tissue breakdown.

A 12-year-old female with developmental delay presented to the emergency department (ED) 3 days after ingesting 2 “bucky ball” metal magnets resembling BB pellets. She presented with, decreased oral intake, dysphagia, and a globus sensation. Her father had “bucky ball” magnets with him. Plain films of the neck, chest, and abdomen revealed 2 metallic FBs in the right hypopharynx (Figure 1); the remainder of the aerodigestive tract was unaffected. Flexible laryngoscopy revealed a gold magnet straddling the right glossoepiglottal fold (Figure 2). The magnets the father brought were used to determine the strength of the magnetic force between the pair and to practice grabbing the magnets with different forceps for extraction. The child was intubated and placed in suspension laryngoscopy. With an assistant holding a 0° telescope for visualization, the surgeon used a McGill forceps and a peanut forceps to break the force between the magnets and extract them simultaneously. The magnets had caused pressure necrosis of the intervening tissue with near erosion (Figure 3). The patient was observed with no further intervention and recovered with no complications.

Figure 1.

X-ray of neck (A) anteroposterior view of 2 spherical metallic foreign bodies in the right hypopharynx (B) lateral view of the foreign bodies in the hypopharynx.

Figure 2.

Laryngoscopy of gold spherical magnet straddling the right glossoepiglottal fold.

Figure 3.

Follow-up laryngoscopy showing pressure necrosis where intervening magnets were.

The majority of FB ingestion episodes occur in children younger than 3 years. ^3,4 Neurological impairment can lead to older children presenting, often late, with FBs in the aerodigestive tract, and higher complication rates. ⁵ This child was 12 years old, developmentally delayed and presented to the ED 3 days after ingesting the magnets. With the introduction of BB-sized powerful magnets as toys in 2008, there has been an increased number of magnetic FB ingestions and injuries, which has prompted the Consumer Product Safety Commission to take legal action in limiting the sales of these magnets. ⁶ To our knowledge, there has only been one other case reported of earth metal spherical magnets being lodged in the hypopharynx. ² Ingestion of more than 1 magnet poses a high risk of injury due to the strong magnetic forces trapping mucosa in between necessitating an early recognition to prevent erosions and perforations. In a large meta-analysis of FB ingestions, magnets were the most common inorganic FB to cause injury in the aerodigestive tract. ⁷ Before extraction, imaging should be performed to visualize the entire aerodigestive tract to ascertain that no other magnets are present. Chevalier Jackson, often referred to as the father of American broncho-esophagoscopy, was a staunch proponent of rehearsing with instruments to emulate FB retrieval before performing procedures on patients to avoid injury and complications and this was useful in the child presented here. ⁸

With a rise of rare earth metal magnet toys, magnetic FBs pose a significant risk for injuries in the aerodigestive tract especially in the young and developmentally delayed. Magnets lodged in the hypopharynx may cause pressure necrosis, necessitating prompt otolaryngologic intervention.