Migratory Foreign Bodies in the Neck: Possible Role for Endoscopic Surgery

Abstract

Foreign body ingestion is a common ENT emergency case among the pediatric population. Most of the ingested foreign bodies pass naturally through the gastrointestinal (GI) tract without any complications; however, in about 10% of these cases may require a non-operative intervention and less than 1% may require a surgical procedure. Sharp ingested foreign bodies may lodge in the base of the tongue, the palatine tonsil, the pyriform sinus, the vallecula, and the oesophagus. Only a small number of those lodged foreign bodies may perforate the pharynx or the oesophagus and even a smaller number may migrate extraluminally. Transversely oriented foreign bodies have a larger tendency to perforate the wall of the hypopharynx and the oesophagus. This happens due to a local inflammation plus the contractions of the hypopharynx muscles during deglutition which leads the foreign body to penetrate the wall. Most of these migratory foreign bodies are usually sharp objects like fish bone, chicken bone or metallic components. 1,2Depending on the direction and site of migration, those migratory foreign bodies may lead to severe complications like periesophageal abscess, mediastinitis, retropharyngeal abscess, thyroid abscess, deep neck abscess, aortoesophageal fistula, innominate esophageal fistula, subclavian esophageal fistula, and carotid rupture. Any mass or abscess in the head and neck region might be a complication attributed to the migratory body and the medical history of the patient should be taken into careful consideration particularly taking into account any previous records of possible foreign body ingestion. Migratory foreign bodies can also be suspected to be present in any patient who has persistent symptoms following negative esophagoscopy. computed tomography (CT) scan is the gold standard for effectively locating the migratory foreign bodies in the neck and lateral neck exploration is the procedure of choice to remove those foreign bodies. 1,2Endoscopic surgery also has been performed in treating all aspects of head and neck surgery. The results from previous studies on neck endoscopic surgery have shown at least equivalent functional and oncological outcomes. Other advantages include the avoidance of external incisions, improved functional outcomes, a post-operative pain, decreased blood loss, and shorter hospital stays. Disadvantages of endoscopic surgery include high financial cost, prolonged time for operations, need for special instruments, and expertise.