Penetrating foreign body in the head and neck can be catastrophic from injury to the constellation of vascular and neural structures in the neck. Early recognition and prompt surgical intervention is imperative to save lives. Herein, we present an unusual case of iatrogenic foreign body—a coiled guidewire embedded in the deep neck space. The complications, radiological investigation and multidisciplinary surgical management are further discussed.

BACKGROUND. Acinic cell carcinoma (ACC) is a rare malignant salivary gland tumour. It is of a low-grade type. The commonest site involved is the parotid gland. ACC is not common in minor salivary glands; this tumour type mainly arises in the oral cavity. CASE REPORT.We present an 84-year-old Malay man with spontaneous, self-limiting, left-sided epistaxis for 2 days. He also had progressive left-sided nasal blockage. There was no hyposmia, blurry vision or headache. He had underlying hypertension. The clinical examination showed he was normotensive. There was no external nasal deformity. The anterior rhinoscopy demonstrated a fungating irregular mass filling up the left nasal vestibule. There was no neck node. The computed tomography showed a tumour localized in the nasal cavity. The biopsy showed features of acinic cell carcinoma. We proceeded with left lateral rhinotomy and wide excision. Intraoperatively, we discovered that the tumour aroused from the nasal septum and part of the septum had to be sacrificed for margin clearance. Currently, he is on routine surveillance and tumour-free. CONCLUSION.We highlighted the importance of recognizing nasal acinic cell carcinoma and the fact that early biopsy is important as surgery provides a good prognosis even in the extreme age group.