Clinical Approaches to Migrating Ingested Foreign Bodies in the Neck

Abstract

This report presents 2 unusual cases along with a review of the current literature. Further, it aims to propose an algorithm for the initial surgical management of migrating ingested foreign bodies, focusing on the use of fluoroscopy, rigid laryngopharyngoscopy, and an external surgical approach. A 42-year-old man presented with progressive odynophagia after swallowing a fish bone 20 days previously, and a 60-year-old woman presented with a painful enlarging mass over the left lower neck for 1 month. The first case involved a horizontally oriented pharyngeal fish bone with a portion in the neck, which was removed under fluoroscopic guidance and rigid laryngopharyngoscopy in succession. In the second case, there was an extraluminal fish bone that had migrated into the sternocleidomastoid muscle, which was retrieved through cervical incision. All foreign bodies were removed without complications. To the best of our knowledge, this is the second report of fluoroscopy-guided ingested foreign body retrieval and the first one with a proposed algorithm for the management of migrating ingested foreign body in the neck. The location and orientation of migrating ingested foreign bodies as well as their relation to structures in the neck are important factors in determining the surgical approach.