Clinical Approaches to Migrating Ingested Foreign Bodies in the Neck

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.

Transluminal Migration of Oesophageal Foreign Bodies: A Series of Three Patients

“…Therefore, high index of clinical suspicion by the examining surgeon is the most important tool for early diagnosis and detection the perforating FB. During rigid oesophagoscopy, one study suggested using a biopsy forceps to explore the ulcerative spot in the hope of retrieving imbedded sharp FB [12]. In terms of neck exploration technique, after a transcervical incision, we approached the tracheoesophageal groove in the first place, then identified the recurrent laryngeal nerve and its groove before proceeding for neck exploration.…”

Migratory fishbones in the pharynx: a report of two cases

“…Sharp fish bones are more prone to cause mucosal damage. Moreover, muscle contractions after entering the pharynx may contribute to migration 4 . Migratory fish bones are associated with an increased incidence of complications.…”

Migratory fish bone in the pharynx, a report of 2 cases

“…However, it is difficult to determine the precise localisation of fish bone in cases with an endoscopically invisible fish bone. Sharp fish bone is prone to damage to the mucosa, and muscle contractions after entering into the pharynx may contribute to the migration 4 . Migratory fish bone is associated with an increased incidence of complications.…”