Hoa visited Tam Anh General Hospital in Ho Chi Minh City complaining of pain and swelling around her eye socket and cheek. A nasal endoscopy revealed swollen nasal mucous membranes and pus discharge. A computed tomography (CT) scan of her face showed a wide maxillary sinus opening with air bubbles, blocked openings in both ethmoid sinuses, and blocked frontal sinus passages. She was diagnosed with acute multi-sinusitis and polyp-like thickening of the maxillary sinus mucosa.

On 16/8, Dr. Tran Thi Thuy Hang, Head of the Otolaryngology Department at the hospital's ENT Center, stated that the foreign object was firmly attached to the nasal structure, completely obscured by pus and inflamed tissue, suggesting it had been there for a long time. The foreign body had created a dangerous infection, damaging the nasal and sinus structure. Left untreated, the infection could spread from the sinuses to the eye socket, causing orbital cellulitis and abscesses, and potentially reaching the brain, leading to meningitis or a brain abscess. Pus and chronic sinusitis can erode the mucous membrane, causing ulcers, perforation of the nasal septum, nasal adhesion, or sinus bone erosion.

A CT scan shows the foreign object within the opacity in the middle nasal passage and ethmoid sinus near the left eye socket. Photo: *Tam Anh General Hospital*

The surgical team performed an endoscopic procedure to remove the foreign object, which turned out to be fragmented pieces of surgical gauze covered in pus. They then suctioned out the mucus and pus, widened the sinus opening, and drained pus cysts on both sides. Continuing to open the right and left ethmoid sinuses, the team observed degenerated ethmoid mucosa with polyps, so they performed an anterior and posterior ethmoidectomy and placed merocel (a soft, sponge-like material) in both nasal cavities, followed by pharyngeal suction.

Post-surgery, Hoa's pain and swelling subsided, her nasal congestion decreased, and she was discharged after one day.

Dr. Hang performing endoscopic sinus surgery to remove the gauze from Hoa's nose. Photo: *Tam Anh General Hospital*

Dr. Hang added that infections caused by foreign objects in the nose or other organs can lead to life-threatening sepsis, particularly in individuals with diabetes or weakened immune systems. These patients also face the risk of permanent loss or reduction of smell and recurring chronic inflammation, which is difficult to treat completely even after the gauze is removed.

Patients experiencing unusual symptoms such as foul-smelling pus discharge, nasal pain, loss of smell, reduced sense of smell, nasal congestion, or recurring sinusitis should seek consultation at medical facilities with otolaryngology departments for endoscopy and CT scans to receive timely diagnosis and treatment.

Uyen Trinh