Fish bones are one of the most frequently observed ingested foreign bodies in the pharynx-esophagus. Fish bones have a tendency to stick and penetrate the mucosa, which can occasionally lead to severe or lethal complications. The extraluminal migration of fish bones in the upper digestive tract is a rare event, and it is even more unlikely that the foreign body will remain in the neck for a prolonged period. We report the unique case of a 69-year-old woman who remained asymptomatic, while a fish bone was lodged in her neck for 9 months. Finally, after her anterior neck had become swollen, she underwent neck exploration, which revealed that the fish bone was embedded in the scar tissue running from within the thyroid gland to outside of the thyroid. Treatment proceeded without complications, and the foreign body was removed successfully. The length of the fish bone was 34 mm. Intraoperative ultrasonography was able to identify the fish bone in situ using real-time imaging; therefore, we recommend this technique for locating migrated foreign bodies in the neck. Ingested fish bones are one of the most frequently observed foreign bodies in the pharynx-esophagus (Remsen et al. 1983;Loh et al. 2000;Athanassiadi et al. 2002); particularly in East Asia, a whole fish is often served without removing its bones. Owing to their fine, linear, and sharp structure, fish bones have a tendency to stick and penetrate the mucosa, which can occasionally lead to severe or lethal complications. The extraluminal migration of fish bones in the upper digestive tract has been reported only rarely, and it is even more unlikely that the foreign body will remain in the neck for a prolonged period. In addition, although neck exploration for migrated foreign bodies is a difficult procedure, there are a few studies used intraoperative ultrasonography in the head and neck region (Ng et al. 2003;Masuda et al. 2006). We report the rare case of a migratory fish bone that remained asymptomatic in the neck for 9 months before its removal, and include a review of the related literature. Clinical ReportA 69-year old woman was referred to our institution with an enlarged anterior neck. Local neck symptoms had worsened compared with those a few days before presentation. A computed tomography (CT) scan revealed a softtissue shadow of increased density, and a fine linear radiopaque object was found located in the right neck region. The patient remembered that a fish rib bone had stuck in her throat while she was eating a grilled fish (a horse mackerel) 9 months ago, although she had been asymptomatic until the present time.Physical examination revealed skin flare and swelling on the anterior neck across a region that was approximately 60 mm in diameter, and the center part of the involved area had an eroded surface with easy bleeding. No fever was present and the patient did not report tenderness in the affected region. No abnormal findings were found in any other region of the head and neck. A blood examination revealed slightly increased levels of white...

We sought to characterize the effectiveness of concomitant chemoradiotherapy (CCRT) for patients with squamous cell carcinoma of the temporal bone. We performed a retrospective chart review of 14 patients with cancer of the temporal bone who were provided initial treatment in our hospital from December 2001 to November 2008. Four patients with stage I tumors were treated by radiation therapy alone or with oral administration of S1. One patient with a stage II tumor was treated by radiation therapy concomitant with low dose docetaxel. Nine patients with stage IV tumors were treated by CCRT using the TPF regimen (docetaxel, cisplatin, and 5-fluorouracil). As an initial treatment, all patients but one were treated by radiation therapy with or without chemotherapy. Grade 4 adverse events of patients who received CCRT using the TPF regimen involved the leukopenia in one patient and the neutropenia in two patients. Local recurrences were observed in three patients including two patients with T4 tumors. Five-year disease-specific survival rates for all patients and for patients with T4 tumors were 78% and 67%, respectively. CCRT using the TPF regimen is safe and effective as the first treatment for patients with cancer of the temporal bone.

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