Foreign body in the throat migrating through the common carotid artery

Migrating fish bone presenting as a neck fistula

The case report describes an extremely rare finding of fish bone migration from the aerodigestive tract causing a neck fistula 2 years after its ingestion. Detailed case study and surgical treatment is presented. This case highlights the need for further assessment in presence of a high clinical suspicion of foreign body ingestion with a normal physical examination of the upper aerodigestive tract, to avoid serious and potential life-threatening complications later on.

Clinical Approaches to Migrating Ingested Foreign Bodies in the Neck

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.

Sewing needle migrating from esophagus into prevertebral space: A challenging case

Oesophageal foreign body presents as a medical emergency and requires immediate evaluation and treatment. We are reporting a rare case of sewing needle in esophagus migrating into the prevertebral space at thoracic inlet level. A 13-year-old mentally retarded female child was brought in emergency at midnight with complaint of accidental ingestion of sewing needle with the thread. Patient was posted for rigid esophagoscopy under general anaesthesia, no needle could be visualised and only thread of the sewing needle was removed. So patient was taken up for neck exploration along with gastroenterologists. Further careful dissection confirmed the needle in the pre vertebral space, which was removed successfully with artery forceps. Patient was given IV antibiotics for 10 days. Patient had an uneventful recovery and was discharged after 10 days. Pointed metallic slender foreign bodies can perforate and migrate very fast in the neck or chest and can lead to morbidity and mortality. Multidisciplinary approach offers a great advantage in surgical planning and proper patient management.

An Unusual Bullet Trajectory: Entered Through the Face and Ended Up in the Neck

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.

Republished: Endovascular retrieval of dental needle retained in the internal carotid artery

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.

Endovascular retrieval of dental needle retained in the internal carotid artery

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.

A Bullet Entered through the Open Mouth and Ended Up in the Parapharyngeal Space and Skull Base

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.

Undetected metallic chopstick stabbed on neck resulting tinnitus and foreign body sensation

Penetrating neck injuries constitute 5-10% of all trauma cases. These injuries may cause life-threatening suppurative or vascular complications, but the severity and extent of damage depends upon the inflicting object and the involved structures. If significant complications are not expected, then it is best to leave the foreign body embedded and avoid surgical risks. We present a rare case of a foreign body embedded in the neck causing tinnitus and foreign body sensation.

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.

Migrated pharyngeal fish bone causing spondylodiscitis. Case report

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.

Vertebral artery dissection due to an esophageal foreign body migration: a case report

Unintentional foreign bodies‘ swallowing is a fairly common occurrence in ENT consultation especially among children. They usually pass through the gastrointestinal tract without complications. Migration of a foreign body through the esophageal wall is rare. It represents about 1% to 4% of all cases of foreign bodies‘ ingestion. A 16 year's old female patient has presented to ENT emergency with a painful dysphagia following an accidental ingestion of a metallic pin. Cervical X ray confirmed the presence of the pin while endoscopic investigations have shown no foreign body. Cervical CT scan revealed the migration of the foreign body through the esophageal wall with left vertebral artery dissection. Endoscopic management has been sufficient with an uneventful post operative follow up. Esophageal foreign bodies are very diverse mainly dominated by fish bones (60%) and chicken bones (16%). Metallic pins are rare. The major risks of migration of those foreign bodies are cervical abscess, mediastinitis and oeso-vascular fistulae. Cases of self extrusion through the skin have been reported. Migration of a foreign body through the esophageal wall is rare. Endoscopic management has been sufficient.

Role of imaging in the assessment of impacted foreign bodies in the hypopharynx and cervical esophagus

Impaction of foreign bodies in the upper digestive tract is a serious pathologic condition in ear, nose, and throat practice and is particularly common in children, prisoners, and psychiatric patients. Commonly found objects include fish bones, chicken bones, pieces of glass, dental prostheses, coins, and needles. The goals of the initial patient assessment are to identify the type of object, its location in the gastrointestinal tract, the presence of any associated complications, and the presence of any underlying esophageal conditions. Radiographic evaluation is helpful to confirm the location of foreign bodies and associated complications. Plain films of the neck and chest commonly will show the location of radiopaque objects, such as coins. Both anteroposterior and lateral views are necessary, as some radiopaque objects overlying the vertebral column may only be visible on the lateral view. Multidetector row computed tomography is superior to plain radiographs for the detection of pharyngoesophageal foreign bodies and provide additional crucial information for the management of complicated cases especially related to sharp or pointed ingested foreign bodies.

Diagnosis and treatment of nine cases with carotid artery rupture due to hypopharyngeal and cervical esophageal foreign body ingestion

The aim of our study is to present our experience in the diagnosis and treatment of patients with carotid artery rupture (CAR) due to foreign body ingestion. A total of nine admissions with CAR due to foreign body ingestion were recorded in Second Xiangya Hospital between 1969 and 2011. The carotid artery was sutured with muscle flap coverage in six cases, ligated in three cases. We retrospectively compared different surgical procedures of the patients and their clinical outcomes. Results show that CAR was found in all of these nine cases in imaging examinations or surgery. Among these six patients treated by suture of the carotid artery, five patients had a complete recovery without any complications, one patient underwent common carotid artery (CCA) ligation after suture surgery, but finally died of massive hemorrhage due to uncontrollable infection with carotid artery erosion. Among these three patients treated only by CCA ligation, one patient had no complications, one patient had hemiplegia, and one patient died of severe cerebral edema. Hence, timely diagnosis and open surgery are important for the patients of CAR due to foreign body ingestion. Suture of the carotid artery with muscle flap coverage is a better method compared with ligation of the carotid artery in the treatment of CAR.

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

Impaction of foreign bodies in the upper aerodigestive tract is commonly encountered in ENT practice. The present paper describes an iatrogenic complication with migration of an impacted foreign body (chicken bone) of the hypopharynx into the prevertebral space, after unsuccessful attempt of endoscopic removal. The foreign body was visualized with cervical CT scan lying extraluminally between the major vessels of the neck. An open surgical procedure with neck exploration was necessary for the definite treatment.

An unusual presentation of foreign body in the common carotid artery

Penetrating trauma to neck resulting in arteriovenous (AV) fistula and aneurysms involving the carotid system are uncommon injuries with life-threatening consequences. We report here a case of a young factory worker who developed a traumatic AV fistula with false aneurysm, with however, no other complications. He was successfully operated when he presented to us two months after the injury and is doing well in follow-up.

Bimanual, intra-operative, fluoroscopy-guided removal of nasopharyngeal migratory fish bone from carotid space

Aim:

We report a rare and unusual case of a patient with an ingested fishbone which migrated from the oropharynx to the anterior compartment of the retropharyngeal space and then to the deep neck space in the nasopharynx (i.e. the carotid space). This report aims to describe a successful, minimally invasive method of foreign body removal which avoided both major skull base surgery and any potential life-threatening complications. A secondary aim is to highlight the role of intra-operative fluoroscopy, an under-used tool.

Case report:

We present a 67-year-old man with a history of fish bone impaction but no fish bone visible on plain X-ray or flexible endoscopy. The diagnosis of fish bone lodged in the retropharyngeal space was confirmed by computed tomography. Surgical exploration of the anterior retropharyngeal space failed to locate the fish bone, as it had migrated to a new, unknown location. Intra-operative fluoroscopy was vital for the removal of the fish bone, as it was impossible to see with the naked eye and had migrated from its previously imaged position. The fish bone was finally retrieved bimanually using external pressure on the submandibular region, which displaced the fish bone, and fluoroscopic guidance, which assisted its removal from the nasopharyngeal lumen.

Conclusion:

To the best of our knowledge, this is the first reported case of bimanual, intra-operative, fluoroscopy-guided, intra-luminal removal of a migratory fish bone from the deep neck space in this region of the nasopharynx.

Migratory foreign body of neck in a battered baby: a case report

Only a small number of ingested foreign bodies perforate the esophagus and even smaller fraction migrate extramucosally with no symptoms. Both of these events are even rarer after marble ingestion. We report here a case of battered baby with homicidal marble ingestion which perforated the esophagus and migrated into the soft tissue of neck. It was diagnosed after 21 days asymptomatic period. The foreign body migrated into the tracheo-esophageal groove, lying deep to strap muscles, which was removed by neck exploration.

Migration of a foreign body (staple) from the oral floor to the submandibular space: case report

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.

Protrusion of a migrated fish bone in the neck

Uningested fish bone swallowing is common, but protrusion of the unswallowed fish bone from the neck is very rare. We report a 3-cm fish bone, which was not diagnosed during the patient first visit at emergency room, resulting in a protrusion out of the patient's neck skin 21 days later after ingurgitation of the bone. The migrated fish bone was safety pulled out directly after obtaining computed tomography of the neck to make sure no soft tissue or major artery involved. Migration of ingested fish bone is an uncommon complication, which has the potential risk to cause morbidity and mortality. Therefore, if findings of physical examination, x-rays, or laryngoscope are negative, it is important to recheck the patient if sore throat persists. Obtaining a neck computed tomography or performing gastroendoscopy to rule out the possible mis-swallowing of fish bone should be warranted. To the authors' knowledge, such a case has not been previously reported in medical literature.

Transient ischaemic attack caused by an ingested stingray barb

A 76-year-old woman reported a fishbone stuck in her throat, but no foreign body was identified. Eight weeks later, she experienced a transient ischaemic attack, and a stingray barb was subsequently removed from the right common carotid artery. To our knowledge, this is the first report of the migration of an ingested stingray barb.

Migrating pharyngeal foreign bodies: a series of four cases of saw-toothed fish bones

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.

[Migration and extrusion from the upper digestive tract to the skin of the neck of a foreign body (fish bone)]

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.

Migratory Foreign Body in the Neck

Oesophageal penetration and migration of foreign bodies are fairly rare occurrences. Most reported cases in the literature involve fish bones, which are eventually found in the lateral neck soft tissue or thyroid lobule. We present a case of a migrating fish bone in an elderly female which was found embedded in her right sternocleidomastoid muscle. The fish bone was successfully removed via neck exploration. Appropriate literature is reviewed.

A foreign body in the pharynx migrating through the internal jugular vein

We present an unusual and a rare case study of a 45-year-old woman who had swallowed a sharp pointed metallic foreign body while eating meat. The foreign body had migrated from the cricopharynx through the parapharyngeal space and penetrated the internal jugular vein over a period of 10 days presenting as a tender neck swelling. The management of this case is discussed here in brief.

A Rare Case of a Foreign Body Migration from the Upper Digestive Tract to the Subcutaneous Neck

Ingested foreign bodies are not unusual in Singapore. The most common of these objects are fish bones, which typically become lodged in the tonsils or in the base of the tongue. We report a rare case of an ingested fish bone that migrated from the upper digestive tract and into the soft tissues of the neck just below the skin.

Ingested nail penetrating the neck in an infant

Ingested sharp foreign bodies usually lodge themselves in the pharynx unlike their more common smooth counterparts, which are found in the upper esophagus. These are very rare in infants and pose problems like delayed presentation and occasionally extraluminal migration. A very rare case of through and through penetration of neck by an ingested nail in an infant, which presented 8 months after its ingestion, is reported.