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Stefan AJ, Ghanem T, Mayerhoff R. Single-Port Robotic Removal of a Submucosal Foreign Body in the Distal Hypopharynx. Laryngoscope 2024; 134:588-591. [PMID: 37439371 DOI: 10.1002/lary.30882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/02/2023] [Accepted: 06/20/2023] [Indexed: 07/14/2023]
Abstract
In this report, we present a 55-year-old female with cervical stenosis that underwent C5-C7 anterior cervical discectomy and fusion surgery complicated by hardware failure requiring removal. One screw remained after transcervical hardware removal due to operative difficulty with the risk of exposing the hypopharyngeal submucosal space. The retained screw caused the patient significant discomfort and dysphagia prompting a transoral attempt at removal. Using a hypopharynx blade on an oral retractor for access, the single-port surgical robot successfully removed the foreign body from the distal hypopharynx. In this case, a single-port surgical robot expanded access to the inferior hypopharynx. Laryngoscope, 134:588-591, 2024.
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Affiliation(s)
- Andrew J Stefan
- Wayne State University School of Medicine, Detroit, Michigan, U.S.A
| | - Tamer Ghanem
- Department of Otolaryngology, Henry Ford Health, Detroit, Michigan, U.S.A
| | - Ross Mayerhoff
- Department of Otolaryngology, Henry Ford Health, Detroit, Michigan, U.S.A
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Hussain SZM, KK AMRUTHA, Mohammad AW, Khan M. Migratory Foreign Bodies in the Aerodigestive Tract: The Importance of CT Imaging. Cureus 2022; 14:e21595. [PMID: 35228953 PMCID: PMC8868031 DOI: 10.7759/cureus.21595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2022] [Indexed: 11/23/2022] Open
Abstract
Accidental ingestion of foreign bodies forms a major part of otorhinolaryngological emergencies. It is dangerous, as the foreign bodies tend to perforate the aerodigestive tract. Since endoscopy is diagnostic as well as therapeutic, it is preferred over computed tomography (CT) scan, especially in developing countries. We present a case of a middle-aged man who presented with fever, neck swelling, and a five-day history of accidental ingestion of a foreign body. He underwent upper gastrointestinal endoscopy, which came out as normal. CT) imaging was performed, which showed migration of the foreign body to the parapharyngeal space and resulting abscess formation. The abscess was drained, and the foreign body was removed transcervically. We discuss this case to stress the role of CT imaging in the diagnosis of foreign bodies of the upper aerodigestive tract and propose an algorithm for the management of such cases. Upper gastrointestinal endoscopy alone would be insufficient to diagnose perforating and migrating foreign bodies, which may cause severe complications if left undiagnosed.
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Alsalamah RK, Alaraifi AK, Alsalem AA, Waheed K. Hypopharyngeal Perforation Following Foreign Body Ingestion: A Case Report. Cureus 2021; 13:e19708. [PMID: 34934574 PMCID: PMC8684363 DOI: 10.7759/cureus.19708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2021] [Indexed: 11/05/2022] Open
Abstract
Foreign body ingestion is a common complaint frequently seen in otolaryngology. Some sharp foreign bodies may get impacted in the aerodigestive tract causing a perforation. However, hypopharyngeal perforation is a rare injury that needs early recognition due to its significant morbidity. In this case report, we report a case of hypopharyngeal perforation caused by foreign body ingestion in an adult patient. A 60-year-old female presented with a foreign body sensation in the throat, dysphagia, and odynophagia. A neck CT scan showed a foreign body in the hypopharynx with a collection of free air along the posterior pharyngeal wall. She underwent laryngoscopy and esophagoscopy for examination and foreign body removal. Following the procedure, the patient was treated conservatively for a week and then discharged home in a stable condition. Hypopharyngeal perforation following foreign body ingestion is uncommon. A high index of suspicion is required to reach an early diagnosis and treatment.
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Affiliation(s)
- Raghad K Alsalamah
- Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Abdulaziz K Alaraifi
- Otolaryngology-Head and Neck Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, SAU
| | - Abdulaziz A Alsalem
- Otolaryngology-Head and Neck Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, SAU
| | - Khurram Waheed
- Otolaryngology-Head and Neck Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, SAU
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4
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Miller N, Noller M, Leon M, Moreh Y, Watson NL, Costello J, Hong S. Hazards and Management of Wire Bristle ingestions: A Systematic Review. Otolaryngol Head Neck Surg 2021; 167:632-644. [PMID: 34846958 DOI: 10.1177/01945998211062156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Inadvertently ingested grill brush bristles can lodge in various locations and lead to a variety of injuries. They can also be difficult to identify and remove. Our primary objective was to perform a systematic review of cases reported in the literature, with analysis of trends in clinical presentation and success of diagnostic modalities and treatment approaches. DATA SOURCES Cases of reported grill brush bristle ingestion reported in PubMed, PubMed Central, and Google Scholar databases through April 30, 2021. REVIEW METHODS Databases were searched for the following terms: ("ingestion" OR "injury" OR "barbeque" OR "BBQ" OR "grill" OR "foreign body" OR "brush" AND "wire" OR "bristle"). Data were collected on patient demographics, clinical presentation, and treatment course. Statistical analysis was performed on characteristics with low risk of confounding. RESULTS An overall 57 studies involving 91 patients were included. Grill brush bristles presented most commonly in the upper aerodigestive tract (48/91), followed by the abdomen (26/91) and deep neck (17/91). Computed tomography was the most accurate imaging modality for initial diagnosis, identifying 92.8% of bristles. Less invasive or adjunctive techniques such as endoscopy, intraoperative imaging, or minimally invasive surgery may be useful particularly for bristles located in the head and neck given the low rate of success of transoral surgery (66.7%). CONCLUSION Although this review of retained bristle may be biased toward complex cases, retained grill brush bristles represent an underrecognized and difficult-to-manage hazard. When cases are suspected, clinicians should obtain computed tomography imaging based on presentation and tailor management appropriately.
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Affiliation(s)
- Nathaniel Miller
- Department of Otolaryngology-Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Michael Noller
- Department of Otolaryngology-Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Matthew Leon
- F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Yonatan Moreh
- F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Nora L Watson
- Department of Research Programs, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Justin Costello
- Department of Neuroradiology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Steven Hong
- Department of Otolaryngology-Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Department of Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
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5
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Ho NH, Chang FC, Wang YF. Clinical Approaches to Migrating Ingested Foreign Bodies in the Neck. EAR, NOSE & THROAT JOURNAL 2020; 101:181-185. [PMID: 32791905 DOI: 10.1177/0145561320948787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
This report presents 2 unusual cases along with a review of the current literature. Further, it aims to propose an algorithm for the initial surgical management of migrating ingested foreign bodies, focusing on the use of fluoroscopy, rigid laryngopharyngoscopy, and an external surgical approach. A 42-year-old man presented with progressive odynophagia after swallowing a fish bone 20 days previously, and a 60-year-old woman presented with a painful enlarging mass over the left lower neck for 1 month. The first case involved a horizontally oriented pharyngeal fish bone with a portion in the neck, which was removed under fluoroscopic guidance and rigid laryngopharyngoscopy in succession. In the second case, there was an extraluminal fish bone that had migrated into the sternocleidomastoid muscle, which was retrieved through cervical incision. All foreign bodies were removed without complications. To the best of our knowledge, this is the second report of fluoroscopy-guided ingested foreign body retrieval and the first one with a proposed algorithm for the management of migrating ingested foreign body in the neck. The location and orientation of migrating ingested foreign bodies as well as their relation to structures in the neck are important factors in determining the surgical approach.
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Affiliation(s)
- Nien-Hsuan Ho
- Department of Otorhinolaryngology-Head and Neck Surgery, 46615Taipei Veterans General Hospital and National Yang-Ming University, Taipei
| | - Feng-Chi Chang
- Department of Radiology, 46615Taipei Veterans General Hospital, Taipei.,Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei
| | - Yi-Fen Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, 46615Taipei Veterans General Hospital and National Yang-Ming University, Taipei
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Ma J, Sun Y, Dai B, Wang H. Migration of an Ingested Fish Bone to the Submandibular Gland: A Case Report and Literature Review. Biomed Hub 2020; 4:1-4. [PMID: 31993424 PMCID: PMC6985887 DOI: 10.1159/000501873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 07/03/2019] [Indexed: 11/19/2022] Open
Abstract
Background Fish bone is one of the most common foreign bodies that gets lodged in the upper digestive tract, often located in the tonsil, epiglottis, pear-shaped fossa, and esophagus, where it may be easily located on routine inspection and removed. The forcible swallowing of food such as rice balls after ingesting fish bones by mistake may lead to the migration of the fish bone from the pharynx, throat, or esophagus to the surrounding tissues. Migration most commonly occurs to the soft tissues of the neck, even to the thyroid gland, but migration to the submandibular gland has rarely been reported. Conclusions Foreign body ingestion may cause a series of complications and endanger a patient's life. Cases require high awareness and attentiveness on the part of the first physician to diagnose and manage the condition, and appropriate health education should be imparted to the patient.
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Affiliation(s)
- Jinhua Ma
- Department of Otolaryngology, Cangzhou Central Hospital, Cangzhou, China
| | - Yahui Sun
- Department of General Surgery, Hebei Medical University Fourth Affiliated Hospital, Shijiazhuang, China
| | - Baoqiang Dai
- Department of Otolaryngology, Cangzhou Central Hospital, Cangzhou, China
| | - Hongqin Wang
- Department of Otolaryngology, Cangzhou Central Hospital, Cangzhou, China
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7
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Porrett JK. Rare case of fish bone migration: thrombophlebitis of the internal jugular vein. ANZ J Surg 2019; 90:E26-E27. [PMID: 30974504 DOI: 10.1111/ans.15093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 12/30/2018] [Accepted: 01/08/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Jemma K Porrett
- Department of Otorhinolaryngology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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8
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Chen Q, Chu H, Tong T, Tao Y, Zhou L, Chen J, Liu Y, Peng L. Predictive factors for complications associated with penetrated fish bones outside the upper gastrointestinal tract. Eur Arch Otorhinolaryngol 2018; 276:185-191. [PMID: 30539244 DOI: 10.1007/s00405-018-5242-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 12/06/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE To investigate predictive risk factors for complications associated with migrating fish bones in the surrounding tissue of upper gastrointestinal tract. METHODS A retrospective analysis over 12 years was conducted of 45 cases of buried fish bones in the surrounding tissue of upper gastrointestinal tract with complications. Meanwhile, a control group, including 39 cases of prolonged buried fish bones in the surrounding tissue of upper gastrointestinal tract without complications, was set. Patient clinical data were collected and analyzed to predict the risk factors for complications. RESULTS The results of Chi-square test and univariate analysis both showed a significant difference in length of fish bone (> 2 cm), a history of concurrent medical illness (diabetes mellitus and renal hypofunction), symptoms (medium or heavy pain and dysphagia), and duration of significant symptoms (> 7 days) between the complication group and non-complication group. Multivariate analysis further identified length (> 2 cm), diabetes mellitus, medium or heavy pain, dysphagia, and duration of significant symptoms (> 7 days) as independent risk factors for complications. CONCLUSIONS The consequences of fish bones migrating outside the upper gastrointestinal tract are various in different people. Awareness should be raised when encountering a patient ingesting a long fish bone, having a history of diabetes mellitus, presenting with significant discomforts, or these discomforts lasting for a long time. This study will help practitioners counsel their patients on the risks and `benefits of surgery versus observation of this condition.
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Affiliation(s)
- Qingguo Chen
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, Wuhan, 430030, China
| | - Hanqi Chu
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, Wuhan, 430030, China
| | - Ting Tong
- Department of Otolaryngology-Head and Neck Surgery, Taikang Tongji (Wuhan) Hospital, Sixin North Road No. 322, Hanyang District, Wuhan, China
| | - Yanling Tao
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, Wuhan, 430030, China
| | - Liangqiang Zhou
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, Wuhan, 430030, China
| | - Jin Chen
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, Wuhan, 430030, China
| | - Yun Liu
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, Wuhan, 430030, China
| | - Liyan Peng
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, Wuhan, 430030, China.
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9
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An Unusual Bullet Trajectory: Entered Through the Face and Ended Up in the Neck. J Craniofac Surg 2018; 28:e636-e637. [PMID: 28692511 DOI: 10.1097/scs.0000000000003709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The authors describe a case of gunshot injury in a 26-year-old male patient with an unusual bullet trajectory. The bullet had an entry hole just near the right lateral alar cartilage of the nose, and the trajectory descended through the left side of the neck by route of the hard palate, soft palate, and posterior pharyngeal wall, respectively. Surgical removal of the bullet was achieved with neck exploration. Gunshot injuries of the head and neck necessitate a thorough clinical and radiological evaluation due to the possibility of an unusual bullet trajectory.
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10
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Schneider AL, Hicks KE, Matsuoka AJ. Cervical oesophageal perforation secondary to food consumption in a well-appearing patient. BMJ Case Rep 2017; 2017:bcr-2017-222576. [PMID: 29167221 DOI: 10.1136/bcr-2017-222576] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
A 71-year-old woman presented to the emergency department 8 days after ingesting fish with mild neck pain but otherwise demonstrated no signs of infection. X-rays were negative but CT imaging demonstrated a curvilinear radiodense object extending from the posterior cervical oesophagus through the right thyroid lobe terminating in the neck just a few millimetres from the external carotid artery. Rigid oesophagoscopy and direct laryngoscopy were negative and the neck was explored for the foreign body, which ultimately was encountered after a painstaking dissection of the right neck that included skeletonisation of the recurrent laryngeal nerve. Her postoperative recovery was uneventful and after a 3-day course of intravenous antibiotics she was discharged on oral antibiotics, in good condition and tolerating a soft diet.
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Affiliation(s)
- Alexander L Schneider
- Department of Otolaryngology Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Katherine E Hicks
- Department of Otolaryngology Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Akihiro J Matsuoka
- Department of Otolaryngology Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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11
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Moore K, Khan NR, Michael LM, Arthur AS, Hoit D. Republished: Endovascular retrieval of dental needle retained in the internal carotid artery. J Neurointerv Surg 2017; 9:e26. [DOI: 10.1136/neurintsurg-2016-012771.rep] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2016] [Indexed: 11/04/2022]
Abstract
Intravascular foreign bodies are a known complication of medical and dental procedures. Dental anesthetic needles may be broken off and retained in the oropharynx. These needles have occasionally been reported to migrate through the oral mucosa in to deeper structures. Here we present the case of a 57-year-old man who had a retained dental needle that had migrated into his internal carotid artery. The needle was removed using endovascular techniques. To our knowledge, this is the first report of a retained dental needle being retrieved using this method. We review the literature on intravascular foreign bodies, retained dental needles, and endovascular techniques for retrieval of such foreign bodies.
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12
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Moore K, Khan NR, Michael LM, Arthur AS, Hoit D. Endovascular retrieval of dental needle retained in the internal carotid artery. BMJ Case Rep 2017; 2017:bcr-2016-012771. [PMID: 28274944 DOI: 10.1136/bcr-2016-012771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Intravascular foreign bodies are a known complication of medical and dental procedures. Dental anesthetic needles may be broken off and retained in the oropharynx. These needles have occasionally been reported to migrate through the oral mucosa in to deeper structures. Here we present the case of a 57-year-old man who had a retained dental needle that had migrated into his internal carotid artery. The needle was removed using endovascular techniques. To our knowledge, this is the first report of a retained dental needle being retrieved using this method. We review the literature on intravascular foreign bodies, retained dental needles, and endovascular techniques for retrieval of such foreign bodies.
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Affiliation(s)
- Kenneth Moore
- University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Nickalus R Khan
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - L Madison Michael
- Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA
| | - Adam S Arthur
- UT Department of Neurosurgery/Semmes-Murphey Clinic, Memphis, Tennessee, USA
| | - Daniel Hoit
- Department of Neurosurgery, University of Tennessee, Memphis, Tennessee, USA
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13
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Comoglu S, Enver N, Sen C, Aydemir L. Migration of a foreign object to the parapharyngeal space: an unusual factitious disorder. Braz J Otorhinolaryngol 2016; 86:261-263. [PMID: 27381878 PMCID: PMC9422471 DOI: 10.1016/j.bjorl.2016.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 05/16/2016] [Indexed: 12/02/2022] Open
Affiliation(s)
- Senol Comoglu
- Istanbul University, Istanbul Faculty of Medicine, Department of Otorhinolaryngology and Head & Neck Surgery, Istanbul, Turkey
| | - Necati Enver
- Istanbul University, Istanbul Faculty of Medicine, Department of Otorhinolaryngology and Head & Neck Surgery, Istanbul, Turkey
| | - Comert Sen
- Istanbul University, Istanbul Faculty of Medicine, Department of Otorhinolaryngology and Head & Neck Surgery, Istanbul, Turkey.
| | - Levent Aydemir
- Istanbul University, Istanbul Faculty of Medicine, Department of Otorhinolaryngology and Head & Neck Surgery, Istanbul, Turkey
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Baylis J, Balfour N. Barbecue blunder: ED removal of a pharyngeal wire bristle foreign body. Am J Emerg Med 2016; 34:1328.e5-6. [PMID: 26782802 DOI: 10.1016/j.ajem.2015.12.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 12/16/2015] [Indexed: 11/26/2022] Open
Affiliation(s)
- Jared Baylis
- Department of Emergency Medicine, Kelowna General Hospital, The University of British Columbia, Kelowna, British Columbia, Canada.
| | - Nick Balfour
- Department of Emergency Medicine, Kelowna General Hospital, The University of British Columbia, Kelowna, British Columbia, Canada; British Columbia Emergency Health Services, Vancouver, British Columbia, Canada.
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A Bullet Entered through the Open Mouth and Ended Up in the Parapharyngeal Space and Skull Base. Case Rep Emerg Med 2015; 2015:680279. [PMID: 26137326 PMCID: PMC4475538 DOI: 10.1155/2015/680279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 05/25/2015] [Indexed: 11/26/2022] Open
Abstract
Shot from a revolver from a close range, a bullet pierced the chest of a policeman and entered through the open mouth of a young male person standing behind. The entry wound was found in the cheek mucosa adjacent to the left lower third molar. After hitting and fracturing the body and the ramus of the mandible, the bullet was deflected and was finally lodged in the parapharyngeal space and skull base, anterolateral to the transverse process of the atlas. The great vessels of the neck were not injured. The patient's condition was very critical but his life could be saved. The bullet was approached through a modified Blair's incision and was found to be lying over the carotid sheath. It was removed safely and the patient recovered completely.
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16
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Shergill GS, Nayak DR, Dora A, Shergill AK. Migrating foreign bodies in the upper aerodigestive tract: a surgical challenge. BMJ Case Rep 2015; 2015:bcr-2015-210326. [PMID: 25994437 DOI: 10.1136/bcr-2015-210326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Migrating foreign bodies in the aerodigestive tract are uncommon but can pose serious complications. Long-standing migrating foreign bodies can exist manifesting chronic and unusual symptoms such as chronic cough, recurrent episodes of dyspnoea and fever. Adverse body reactions to foreign objects such as adhesions can cause difficulty in their diagnosis, localisation and removal. A thorough clinical and radiographical approach is of immense value in such cases. We report two difficult cases of migrated foreign bodies: a 2-year-old child with a long-standing foreign body that migrated to the upper mediastinum, and an adult patient with a fish bone that migrated to the oropharyngeal muscles. Presentations of these cases were not alike, with chronic unusual recurrent symptoms in one and typical acute symptoms in the other. The diagnosis and precise localisation of both foreign bodies was challenging, and an open approach was employed to remove them.
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Affiliation(s)
- Gurshinderpal Singh Shergill
- Department of ENT, Head and Neck Surgery, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Dipak Ranjan Nayak
- Department of ENT, Head and Neck Surgery, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Asheesh Dora
- Department of ENT, Head and Neck Surgery, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Ankur Kaur Shergill
- Department of Oral Pathology and Microbiology, Manipal College of Dental Sciences, Manipal, Manipal University, Manipal, Karnataka, India
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Okumura Y, Hidaka H, Seiji K, Nomura K, Takata Y, Suzuki T, Katori Y. Unique migration of a dental needle into the parapharyngeal space: successful removal by an intraoral approach and simulation for tracking visibility in X-ray fluoroscopy. Ann Otol Rhinol Laryngol 2014; 124:162-7. [PMID: 25139135 DOI: 10.1177/0003489414547106] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The first objective was to describe a novel case of migration of a broken dental needle into the parapharyngeal space. The second was to address the importance of simulation elucidating visualization of such a thin needle under X-ray fluoroscopy. METHODS Clinical case records (including computed tomography [CT] and surgical approaches) were reviewed, and a simulation experiment using a head phantom was conducted using the same settings applied intraoperatively. RESULTS A 36-year-old man was referred after failure to locate a broken 31-G dental needle. Computed tomography revealed migration of the needle into the parapharyngeal space. Intraoperative X-ray fluoroscopy failed to identify the needle, so a steel wire was applied as a reference during X-ray to locate the foreign body. The needle was successfully removed using an intraoral approach with tonsillectomy under surgical microscopy. The simulation showed that the dental needle was able to be identified only after applying an appropriate compensating filter, contrasting with the steel wire. CONCLUSION Meticulous preoperative simulation regarding visual identification of dental needle foreign bodies is mandatory. Intraoperative radiography and an intraoral approach with tonsillectomy under surgical microscopy offer benefits for accessing the parapharyngeal space, specifically for cases medial to the great vessels.
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Affiliation(s)
- Yuri Okumura
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroshi Hidaka
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazumasa Seiji
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazuhiro Nomura
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yusuke Takata
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takahiro Suzuki
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yukio Katori
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
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18
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Arantes Júnior AA, Malheiros JA, Reis MTDSE, Moraes GMD. Migrated pharyngeal fish bone causing spondylodiscitis. Case report. COLUNA/COLUMNA 2014. [DOI: 10.1590/s1808-185120141301rcc69] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Ingestion of foreign bodies is a common problem seen at emergency rooms and frequently involves chicken and fish bones. There are few cases of migrated foreign bodies through the retropharynx causing infectious process in the area but no one, despite the proximity, causing spondylodiscitis. Perhaps such condition is attributed to the integrity of the longus colli fascia covering and protecting the cervical spine. We described the first case of spondylodiscitis due to a foreign body (saw-toothed fish bone) that penetrated the longus colli fascia and carved into vertebral body C3.
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Pai K, Pillai S, Bhandarkar A, Anand A, Sabhahit H. Migrating Ingested Foreign Body of the Upper Aerodigestive Tract with Resultant Septic Shock: Case report and literature review. Sultan Qaboos Univ Med J 2013; 13:606-10. [PMID: 24273677 DOI: 10.12816/0003326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 06/09/2013] [Accepted: 06/18/2013] [Indexed: 11/27/2022] Open
Abstract
Complications due to foreign body ingestion are rare; however, if present, these can cause significant morbidity to the patient. An overlooked ingested foreign body could present as an emergency and may prove fatal. We present a case of an accidentally ingested foreign body with delayed presentation, which migrated to the neck and produced a cervical abscess presenting as septic shock. The patient required prompt stabilisation followed by surgical intervention. The patient's vital signs returned to normal on the second post-operative day, and he was discharged the following day.
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Affiliation(s)
- Keshav Pai
- Kasturba Medical College, Manipal, India
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Lu Q, Bao J, Pei Y, Jing Z. Temporary Balloon Occlusion of Both the Superior Vena Cava and the Internal Jugular Vein to Achieve Removal of a Migrated Foreign Body. Ann Vasc Surg 2009; 23:687.e9-13. [DOI: 10.1016/j.avsg.2009.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2008] [Revised: 02/24/2009] [Accepted: 03/17/2009] [Indexed: 11/30/2022]
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Migration of a foreign body (staple) from the oral floor to the submandibular space: case report. Br J Oral Maxillofac Surg 2009; 48:145-6. [PMID: 19467745 DOI: 10.1016/j.bjoms.2009.04.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2009] [Indexed: 10/20/2022]
Abstract
We report a case of foreign bodies, staples, accidentally put in the oral cavity. One of the staples had migrated from the oral floor through the submandibular space and penetrated the submandibular gland. The staple was removed successfully using CT scan and fluoroscope imaging.
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Chung SM, Kim HS, Park EH. Migrating pharyngeal foreign bodies: a series of four cases of saw-toothed fish bones. Eur Arch Otorhinolaryngol 2008; 265:1125-9. [PMID: 18175137 DOI: 10.1007/s00405-007-0572-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2007] [Accepted: 12/20/2007] [Indexed: 02/07/2023]
Abstract
Pharyngeal foreign bodies are common problems seen at emergency rooms or ENT outpatient clinics, and fish bones are the most common foreign bodies encountered in East Asia and in Korea. One of the rare complications of a swallowed sharp fish bone is its migration from the site of entry into the subcutaneous tissues of the neck. We present four unusual cases of ingested fish bones that migrated out of the upper digestive tract to the neck. In the first case, this caused a recurrent deep neck infection for 2 years; in the second case, there was penetration of the facial artery; in the third case, there was a hematoma of the floor of the mouth; in the fourth case, there was a retropharyngeal abscess.
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Affiliation(s)
- Sung Min Chung
- Department of Otolaryngology, Ewha Womans University School of Medicine, Seoul, South Korea
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Complicated hypopharyngeal perforation caused by a foreign body. MEDICINSKI PREGLED 2007; 60:391-6. [PMID: 17990808 DOI: 10.2298/mpns0708391c] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The paper describes a patient who ingested a piece of bone during his meal. A Jbreign body was suspected and admission to the hospital was recommended as well as esophagoscopy, which he refused. Approximately 48 hours after the meal, the patient was admitted to the hospital for increased temperature, neck pain, and swollen right side of neck. Assuming that the condition was a result of hypopharyngeal perforation cased by a foreign body, computed tomography was performed A collection oJ'pus was found in the lateral and anterior neck compartments with subcutaneous tissue edema, and a foreign body was found in the projection of the hypopharynx. A wide incision was made under general anesthesia and drainage was performed using surgical drains and nasogastric tube. Antibacterial therapy was also applied. The patient was dismissed from the hospital in good general condition. Complications involving a foreign body in the hypopharynx and/or esophagus require urgent attention and adequate diagnosis and therapy. A correct indication, good choice of surgical procedure and intensive antibacterial therapy increase the chance of cure in such patients.
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Maseda E, Ablanedo A, Baldó C, Fernández MJ. [Migration and extrusion from the upper digestive tract to the skin of the neck of a foreign body (fish bone)]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2007; 57:474-6. [PMID: 17228649 DOI: 10.1016/s0001-6519(06)78752-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Foreign bodies ingestion is a common problem seen at emergency rooms and mostly involved are fish and chicken bones. The diagnosis can be difficult because of the age of the patient (children and older patients with dental prosthesis). The shape of the foreign body leds to the course of the pathology, with possible mayor complications like migration into the fascial spaces of the neck, retropharyngeal abscess and perforation of the pharynx or esophagus which have the potential to cause morbidity and mortality. We present a 88-year-old lady who swallowed a 3 cm linear sharp fish bone which migrated from the pharynx to the skin of the neck, surfaced through a fistulous orifice and threw out six weeks later. No intervention was needed. A discussion of the management of migrated foreign bodies follows.
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Affiliation(s)
- E Maseda
- Servicio de Otorrinolaringología del Hospital San Agustín, Avilés, SESPA.
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