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Bimanual, intra-operative, fluoroscopy-guided removal of nasopharyngeal migratory fish bone from carotid space

Published online by Cambridge University Press:  19 January 2010

J A Al-Abduwani ,
D Bhargava ,
S Sawhney  and
R Al-Abri
J A Al-Abduwani
Affiliation:
ENT Division, Department of Surgery, College of Medicine, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman
D Bhargava*
Affiliation:
ENT Division, Department of Surgery, College of Medicine, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman
S Sawhney
Affiliation:
Department of Radiology, College of Medicine, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman
R Al-Abri
Affiliation:
ENT Division, Department of Surgery, College of Medicine, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman
*
Address for correspondence: Dr Deepa Bhargava, Department of Surgery, ENT Division, College of Medicine, Sultan Qaboos University, PO Box 35, Al Khod, Muscat 123, Sultanate of Oman. Fax: 968 24413325 E-mail: [email protected]
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Abstract

Aim:

We report a rare and unusual case of a patient with an ingested fishbone which migrated from the oropharynx to the anterior compartment of the retropharyngeal space and then to the deep neck space in the nasopharynx (i.e. the carotid space). This report aims to describe a successful, minimally invasive method of foreign body removal which avoided both major skull base surgery and any potential life-threatening complications. A secondary aim is to highlight the role of intra-operative fluoroscopy, an under-used tool.

Case report:

We present a 67-year-old man with a history of fish bone impaction but no fish bone visible on plain X-ray or flexible endoscopy. The diagnosis of fish bone lodged in the retropharyngeal space was confirmed by computed tomography. Surgical exploration of the anterior retropharyngeal space failed to locate the fish bone, as it had migrated to a new, unknown location. Intra-operative fluoroscopy was vital for the removal of the fish bone, as it was impossible to see with the naked eye and had migrated from its previously imaged position. The fish bone was finally retrieved bimanually using external pressure on the submandibular region, which displaced the fish bone, and fluoroscopic guidance, which assisted its removal from the nasopharyngeal lumen.

Conclusion:

To the best of our knowledge, this is the first reported case of bimanual, intra-operative, fluoroscopy-guided, intra-luminal removal of a migratory fish bone from the deep neck space in this region of the nasopharynx.

Keywords

PharynxForeign BodiesX-Ray Diagnosis
Type
Short Communications
Information
The Journal of Laryngology & Otology , Volume 124 , Issue 7 , July 2010 , pp. 786 - 789
Copyright
Copyright © JLO (1984) Limited 2010

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