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Foreign body ingestion is a common ENT emergency case among the pediatric popu-lation. 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.
ISSN 2470-4059 http://dx.doi.org/10.17140/OTLOJ-3-138 Open Journal Opinion Migratory Foreign Bodies in the Neck: * *Corresponding author Possible Role for Endoscopic Surgery Omar Ramadan, PhD ENT Registrar Independent Researcher * Paterson, NJ 07533, USA Omar Ramadan, PhD* Tel. +1 973 563 9283 E-mail: omarram982@hotmail.com Independent Researcher, Paterson, NJ 07533, USA Volume 3 : Issue 2 Article Ref. #: 1000OTLOJ3138 Foreign body ingestion is a common ENT emergency case among the pediatric popu- lation. Most of the ingested foreign bodies pass naturally through the gastrointestinal (GI) tract Article History without any complications; however, in about 10% of these cases may require a non-operative nd Received: February 22nd, 2017 intervention and less than 1% may require a surgical procedure. Sharp ingested foreign bodies st Accepted: March 1st, 2017 may lodge in the base of the tongue, the palatine tonsil, the pyriform sinus, the vallecula, and nd Published: March 2nd, 2017 the oesophagus. Only a small number of those lodged foreign bodies may perforate the phar- ynx 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 Citation Ramadan O. Migratory foreign bod- oesophagus.
This happens due to a local inflammation plus the contractions of the hypopharynx ies in the neck: Possible role for en- muscles during deglutition which leads the foreign body to penetrate the wall. Most of these doscopic surgery. Otolaryngol Open migratory foreign bodies are usually sharp objects like fish bone, chicken bone or metallic J. 2017; 3(2): 28-29. doi: 10.17140/ 1,2 components.
OTLOJ-3-138 Depending on the direction and site of migration, those migratory foreign bodies may lead to severe complications like periesophageal abscess, mediastinitis, retropharyngeal ab- scess, thyroid abscess, deep neck abscess, aortoesophageal fistula, innominate esophageal fis- tula, 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 previ- ous 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 for- eign bodies in the neck and lateral neck exploration is the procedure of choice to remove those 1,2 foreign bodies.1,2 Endoscopic 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.3 Endoscopic surgery has been performed to remove any foreign body from the chest, abdomen, and pelvis. For example, Murugan et al4 reported a case of migratory orthopedic screw in bladder which was handled endoscopically. Motallebzadeh et al5 reported a case of liver abscess due to the ingestion of a foreign body that had migrated through the stomach and endoscopic removal of the fish bone was performed. von Riedenauer et al6 reported the removal of a migratory acupuncture needle causing pneumothorax from the chest wall using video- Copyright assisted thoracoscopy.
©2017 Ramadan O. This is an open access article distributed under the In the neck, presence of migratory foreign bodies has been reported in the retropha- Creative Commons Attribution 4.0 ryngeal, parapharyngeal, and carotid sheath, tracheoesophageal groove, thyroid and skin. Us- International License (CC BY 4.0), which permits unrestricted use, dis- ing endoscopic surgery, most of the neck regions to which foreign bodies may immigrate are tribution, and reproduction in any accessed, so we can use endoscopic surgery to remove the migratory foreign bodies in the neck. medium, provided the original work In Table 1, surgical approaches are proposed to remove foreign bodies from different regions of is properly cited.
ISSN 2470-4059 http://dx.doi.org/10.17140/OTLOJ-3-138 Open Journal
Parapharyngeal Tracheoesophageal Thyroid migratory FB Retropharyngeal migratory FB Carotid Sheath migratory FB Traditional Lateral neck exploration Hemithyroidectomy Lateral neck approach Approach Endoscopic - Supine position - Supine position - Supine position Approach - General anaesthesia - General anaesthesia - General anaesthesia - A 15 mm skin incision over the anterior - Injection at the subplatysmal layer of the - Boyle-Davis gag was inserted, edge of the SCM was made through the anterior neck and oral vestibulum - A midline incision was made through the area in subcutaneous tissue and Platysma at - 2.5 cm incision at the vestibule between the which the foreign body was lodged. the level of the foreign body inferior lip and gingiva in order to reach the - After removing the foreign body, the pharyngeal - A rigid endoscope was passed through subplatysmal layer mucous membrane is sutured.
the incision. The endoscope is - Subplatysma dissection is done, extending - The patient should be fed using a nasogastric controlled by the assistant, while the down to the suprasternal notch and laterally up 9 tube for a week.
primary surgeon performs blunt to the medial border of the sternocleidomastoid dissection muscle.
- Subplatysmal flaps were raised - Two Kirschner wires with a diameter of 1.2 mm superiorly and inferiorly are inserted horizontally in the subplatysmal - Dissection between the fascia of layer SCM and strap muscles was done; - After the isolation of strap muscles, the thyroid retraction of SCM was done laterally gland is revealed and the isthmus is transected and laryngeo-tracheal system with a Harmonic scalpel after blunt dissection of medially to explore the parapharyngeal, the thyroid gland from the trachea tracheoesophageal groove, and the - The dissection of the upper pole, the superior carotid sheath.
thyroid artery and vein is performed and the medial thyroid vein is also cut off using the Harmonic scalpel.
- After preparation of the retrothyroidal area, the recurrent laryngeal nerve is identified and the inferior thyroid artery is divided.
- The Berry ligament is then carefully divided while avoiding any injury.