Clinical:
- A 60 years old man
- Presented with neck pain
- Radiograph of cervical spine done
- It showed incidental findings of charm needles at face and neck region
- However, clinically these needles are not palpable.
Radiographic findings:
- Numerous linear metallic opacities of similar sizes are sen at facial and neck region
- These opacities conform to shape of needles
- There is no other significant finding
Diagnosis: Charm needles (susuk)
Discussion:
- In Malay culture, charm needles (termed susuk), are needles are which are inserted into the soft tissues by a shaman (termed bomoh).
- Charm needles have various purposes those found in facial region are mainly for cosmetic reasons. Their insertion is supposed to bring beauty.
- Most susuk wearers are secretive about their practice as it is considered “forbidden”. , patients often do not reveal undergoing such practices to the clinicians because of the restrictions given by the shaman or out of fear of being ridiculed due to the taboo associated with it.
- Susuk can be quite perplexing because it is not clinically visible or palpable, neither does it usually show any sign of its placement or scarring due to its presence.
- The needles are alleged to be made of gold or other precious metals. Since no definite confirmation of the metal used, therefore, it cannot be taken for granted that performing MRI in patients would be entirely safe since these metallic objects may carry the hazard of getting displaced into adjacent vital structures, especially if the magnetic strength of the machine is >1.5 T. Due to this reason in all hospital in Malaysia, susuk is still listed as one of MRI contraindication in the checklist form along with cardiac pacemakers and neurotransmitters.
