Iatrogenic migration of an impacted pharyngeal foreign body of the hypopharynx to the prevertebral space

Unusual Case of a Foreign Body in Tracheo-Esophageal Party wall

Foreign body ingestion is a common problem among children and less so with adults. Most patients are asymptomatic and require no treatment while some need acute management depending on type, size, shape, duration, symptoms and physical findings. Here we present an unusual case of foreign body ingestion which perorated through the pyriform fossa and lodged in tracheoesophageal party wall requiring surgical exploration.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-023-03698-1.

Varied Manifestations of Sharp Penetrating Foreign Bodies in the Aerodigestive Tract: Our Experience

Introduction Foreign body ingestion or aspiration is an emergency dealt by otorhinolaryngologists. It is most common among children and the geriatric population. It paves the way for critical morbidity when prompt treatment is not initiated. Therefore, in the absence of strong evidence to guide decision-making, all suspicious presentations of the ingested sharp foreign body need to be kept in mind while making a diagnosis. Hence, our study is aimed to document the varied manifestations of sharp penetrating foreign bodies in the aerodigestive tract. Materials and methods The medical records of 40 patients who presented with sharp foreign body ingestion/aspiration in the department of otorhinolaryngology in our centre from September 2012 to September 2022 were reviewed retrospectively. Results In all 40 patients, we were able to retrieve the foreign body as such without crushing or breaking it. In our study, the most common foreign body retrieved among middle-aged and elderly were chicken bone (22.5%) or fish bone (25%), and the most common foreign body following accidental ingestion in children were stapler pins (20%). Conclusion The findings of our study concluded that relevant clinical history, atypical presentation, and radiological imaging of sharp penetrating foreign bodies in the neck should be addressed with the utmost caution, as foreign bodies migrate to deep neck space and bronchus and can result in untoward complications. Hence, we need to be suspicious of the varied manifestation of aerodigestive tract foreign bodies for early diagnosis and prompt treatment.

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

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.

Metallic foreign body deep in the prevertebral space after an endomyocardial biopsy: a case report

Introduction

Although inspirated or ingested foreign bodies constitute a common otolaryngologic emergency, the removal of a solitary retained foreign body from the neck has seldom been described in the literature. The ingestion of foreign bodies commonly results in perforated viscose or extraluminal migration to adjacent structures quite a long period of time after the fact. To the best of our knowledge, this is the first English language description of an endomyocardial biopsy complicated by a retained foreign body deep in the prevertebral space of the patient’s neck. We report such a case and share our experience in treating it.

Case presentation

A 68-year-old Asian man suffering right-sided heart failure underwent an endomyocardial biopsy via his right internal jugular vein. After undergoing the procedure, he was found to have retained a metallic cup tip which had become lodged in his neck. A surgeon then performed neck exploration and the foreign body was removed without adverse effect.

Conclusions

Decision making as to whether to remove the foreign body or not remains controversial. However, the later incidence of adhesive fibrosis or, even worse, of a catastrophic abscess or adjacent vascular injury might occur if the foreign body was not removed. Early exploration is suggested, if the patient’s condition makes this feasible.

Foreign body impaction of the vertebral canal

Foreign body impactions in the aerodigestive tract are common, but have the potential for serious complications. A foreign body may disrupt the mucosal lining and migrate regionally thereby risking impingement or injury to critical neurovascular structures in the cervical region. It is important to recognize potential complications that may arise from luminal compromise. In such cases, expeditious surgical treatment is warranted.