Do lodged foreign bodies in the neck need to be removed? No defined criteria in 2020. Fluoroscopy role and review of literature: A case report

Abstract

Penetrating neck wounds can be fatal and require prompt attention. The trauma literature is flooded with management protocols for penetrating wounds to the neck; however, in the absence of hard signs the definitive management of lodged foreign bodies beyond the platysma is less clear. This report describes a work-related injury of a Caucasian 33-year-old male who arrived in the Emergency Department (ER) with a 1 cm metallic foreign body (FB) lodged in zone II of the neck, 7 mm antero-lateral to the right internal carotid artery. The technical aspects of its retrieval are discussed as well as a literature review of the current management of embedded FBs in the neck. The patient was taken to the operating room and the FB was removed via a 3 cm incision. Fluoroscopy was used for exact localization of and to allow a precise skin incision overlying the FB. The FB was retrieved uneventfully; a fiberoptic esophagoscopy and bronchoscopy showed normal findings. The patient was discharged home the next day. At 15 months follow-up he is doing well without sequela. The use of fluoroscopy is strongly encouraged for FB removal in asymptomatic patients. The management of lodged foreign bodies in the neck should be part of future guidelines.

Surgical Removal of an Orthodontic Mini-Screw Displaced Into the Lateral Pharyngeal Space: A Case Report and Review of Pertinent Literature

“…Although patients may remain asymptomatic in the immediate aftermath of foreign body dislodgement into head and neck tissues, they are potentially infectious and can put the patient’s life at risk. Especially, iatrogenic foreign body dislodgement of dental instruments, needles and implants carry with them the risk of contamination from oral microbial flora [ 4 , 12 ]. It is therefore advisable to remove any head and neck foreign body to avoid recurrent infections, foreign body reactions and the risk of damage to vital vascular and neurological structures [ 12 ].…”

“…Especially, iatrogenic foreign body dislodgement of dental instruments, needles and implants carry with them the risk of contamination from oral microbial flora [ 4 , 12 ]. It is therefore advisable to remove any head and neck foreign body to avoid recurrent infections, foreign body reactions and the risk of damage to vital vascular and neurological structures [ 12 ].…”

“…Additionally, fluoroscopy using a portable C-Arm x-ray imaging system was used with a metallic dissecting forceps as a radiographic reference (Figure 4 ). Several studies have reported the advantages of using fluoroscopy for intraoperative imaging of foreign bodies, as it enables anatomic visualization in multiple planes [ 5 , 9 - 12 ]. In most of the above studies, a C-Arm x-ray system was the preferred method of fluoroscopic imaging, as was the case in the present study too.…”

Fluoroscopy-Guided Metallic Foreign Body Removal: A Report of Three Cases and Literature Review

“…Severe neck injuries have a high fatality rate. The treatment for these wounds depends on whether the patient exhibits "hard signs" such as airway obstruction, an air bubble wound, an expanding or pulsatile hematoma, active bleeding, hypovolemic shock, hematemesis, and neural deficits or hemodynamic instability during the initial examination [ 15 ].…”

“…There are many management guidelines for penetrating neck trauma; typically, the presence of hard signs necessitates exploratory surgery. However, retained foreign bodies in asymptomatic patients are a controversial entity, and their management necessitates careful consideration and judgment [ 15 ].…”