Grill-Cleaning Wire Brush Bristle Ingestion: Two Cases and Review of Literature with Focus on Diagnostic Approach

Abstract

Foreign bodies contribute to more than half a million emergency department visits each year. 1 Grill-cleaning wire brush bristle is an infrequently identified foreign body with less than 25 published cases. 2 Grill-cleaning brushes are common consumer products. Their thin malleable bristles can break off easily and may be difficult to identify when stuck on food. 3 The sharp metallic bristles can embed into the tissues, making direct and radiographic visualization difficult. We present 2 recent cases and review prior cases of wire brush bristles in the head/neck region available on PubMed with a focus on the diagnostic approach.

Intraoperative Ultrasound for Localization and Removal of an Oropharyngeal Wire Grill-Brush Bristle

“…2 Given that such injuries are often elusive, physicians are advised to maintain a high index of suspicion, especially in the summer months when barbequing is most common. 10…”

“…3 Flexible laryngoscopy has been deemed only moderately sensitive in locating aerodigestive grill bristles (42%-50%), and some favor imaging over endoscopic exam as a primary step in diagnosis. 10 Some reports have proposed use of metal detectors or magnets as a specific, low-cost method of locating metallic foreign bodies during surgery. 11 Fluoroscopy has also been reported as a successful localization technique, 12 although plain radiographs can often be sufficient, particularly as a screening tool.…”

“…2 Given that such injuries are often elusive, physicians are advised to maintain a high index of suspicion, especially in the summer months when barbequing is most common. 10 Imaging is required when examination, including flexible laryngoscopy when available, are negative as wire bristles are radiopaque and readily detectable by multiple imaging modalities. 3 Flexible laryngoscopy has been deemed only moderately sensitive in locating aerodigestive grill bristles (42%-50%), and some favor imaging over endoscopic exam as a primary step in diagnosis.…”

Wire bristle foreign body: Never in the same place twice

“…3 Subsequent cases have included pediatric and adult patients and noted that ingested bristles were commonly located in the base of the tongue, esophagus, palatine tonsils, parapharyngeal space, vallecula, and in the gastrointestinal tract. 1,4–13…”

“…3 Subsequent cases have included pediatric and adult patients and noted that ingested bristles were commonly located in the base of the tongue, esophagus, palatine tonsils, parapharyngeal space, vallecula, and in the gastrointestinal tract. 1,[4][5][6][7][8][9][10][11][12][13] Non-specific patient symptoms, small size, and easy migration make diagnosis and management of ingested wire bristles challenging. For patients with persistent globus, dysphagia, or odynophagia, it is important to maintain a high index of suspicion even with negative endoscopic examinations.…”