CASE REPORT Superglue (Cyanoacrylate) in the Nose Sham K. Duvvi, MS, Stephen Lo, BMEDSCI, MBA, MRCS, DLO, Ravi Kumar, MS, and Paul D. R. Spraggs, FRCS (ORL), London, United Kingdom A ccidental application of cyanoacrylate adhesives (su- perglue) to the skin,eye,ear,and mouth has been widely reported. We report the first case of cyanoacrylate drops accidentally applied into the nasal cavity. The treat- ment of the condition is described and recommendations to the manufacturers to prevent recurrence of this potentially serious situation are made. CASE REPORT A 47-year-old man was undergoing treatment of nasal polyp- osis with steroid nose drops (Vista, Martindale, UK). One evening he accidentally instilled superglue (Loctite) into both of his nostrils having mistaken it for his nasal medication. He presented as an ENT emergency with severe pain and com- plete blockage of the nose. Examination confirmed complete nasal obstruction with both nasal fossae occluded by a solid hard mass of dried cyanoacrylate glue. Attempted removal underlocalanaesthesia was aban- doned because of severe discomfort. The patient was there- fore admitted for endoscopic removal under general anaes- thesia with local vasoconstriction using topical 2% lignocaine and 1:1000 adrenaline. A dried superglue cast was carefully mobilised and removed from each side of the nose with minimal trauma to thenasal mucosa (Fig1A). The patient was advised to continue to use his nasal steroid medication to reduce the inflammation and irritation caused by the glue, and to douche the nose with saline to prevent crusting. Subsequent outpatient review demonstrated no long-term sequelae. DISCUSSION Superglue is chemically a cyanoacrylate product and is widely used for domestic purposes. In the presence of b substances it undergoes a rapid anionic polymerisation and forms a hard solid mass. 1 Some superglue bottles resemble the size and shape of certain medicinal ear,nose,and eye drop bottles (Fig1B),and cases of inadvertent application of cyanoacrylate superglue to the skin, ear, eyes, and m have previously been reported in the literature. 1-5 This is the first case that describes accidental instillation of superg into the nose. Previous authors have described methods of removal of superglue from skin surfaces. They generally involve application of specific solvents such as gammabutyrola- cetone, nail polish remover, pure actone, trichloroethan toluene, xylene, nitromethane, andm e t h y l chloride. 2 In- organic agents such as liquid soap, alkaline water, and warm 3% hydrogen peroxide have alsob e e n used. 3,4 All these substances are toxic and/or irritable and therefor they cannot be applied directly to mucosal surfaces suc as the mouth, eyes, and nasal cavity. There are, howeve nos a f e , nontoxic solvents that can beused o n the mucous membranes, although Cousin 5 described t h e use of saline soaksto mobilisesuperglue from themucosaof the mouth. In this case, it was possible to remove all the glu with minimal trauma to the nasal mucosa using a topica vasoconstrictor agent. In conclusion, the ability of cyanoacrylate adhesives to bond strongly and quickly presents considerable prob lems when it is inserted into the ear, nose, throat, or ey There is no solvent available to release the adhesive fro From the Department of Otolaryngology–Head and Neck Surgery, (Drs Duvvi, Kumar, and Spraggs), North Hampshire Hospital, Basingstoke and Department of Otolaryngology–Head and Neck Surgery (Dr Lo), St. George’s Hospital Medical School, University of London, London, UK. Reprint requests: Dr.Stephen Lo, BMedSci, MBA, MRCS,DLO,4 Osborne Road, Farnborough, Hants GU14 6PT, United Kingdom. E-mail address: stephenlo@lycos.co.uk. Otolaryngology–Head and Neck Surgery (2005) 133, 803-804 0194-5998/$30.00 © 2005 American Academy of Otolaryngology–Head and Neck Surgery Foundation, Inc.All rights reserved. doi:10.1016/j.otohns.2004.09.090