Background Children are curious to learn and are always explorative. This exploration is sometimes by keeping things in the oral cavity resulting in cases of foreign body in the aerodigestive tract. Penetrating oropharyngeal foreign bodies can result in significant morbidity and mortality if not treated promptly. The usual objects implicated in children are pens, pipes and toys which are cylindrical. The injury commonly occurs when the child falls with foreign body in the mouth. Here, we present a case report of a peculiar penetrating oropharyngeal foreign body accident. Case presentation A 7-year-old boy was brought to the emergency room with an alleged history of foreign body insertion into the mouth while playing with a rigid metallic rod which was bent in the end. Following a forceful hit on the head of the child by his sibling from behind, the rod got impacted into the mouth. The screening X-ray revealed an impacted foreign body. Non-contrast computed tomography scan was done on an emergency basis. It revealed hook-shaped metallic foreign body in the oral cavity and penetrating the oropharynx at the tongue base region. The effective total length of FB was 30 cm with an embedded intraglossal component of 2.5 cm. To aid in intubation, the extraoral part of the foreign body was cut short preoperatively. C-MAC video laryngoscope was used to aid in intubation. A backup plan for emergency tracheostomy was made in case of failed intubation. The foreign body was held using Kocher’s artery forceps and removed completely under endoscopic visualisation without any significant bleeding from the site of entry. Conclusion The unusual shape, the relatively narrow space in the patient and the tongue being a vascular structure were challenges in the removal of the foreign body. Due to the hook shape, it had to be withdrawn cephalad for removal. Penetrating oropharyngeal foreign body should not be pulled out either at primary care or in the emergency room but should be referred to experienced ENT surgeons. Critical teamwork between the ENT surgeon and the anaesthetist with well-defined preoperative plans for airway management is necessary. Awareness and ensuring safe play areas for children will prevent a great deal of penetrating oropharyngeal foreign body.

Introduction Goiter is one of the most common conditions encountered clinically (up to 60% of population) with thyroid malignancy being one of the most common endocrine malignancies. The American Thyroid Association has advocated the need for validation of the Bethesda system of fine needle aspiration cytology (FNAC) in each center. The risk of malignancy (ROM) for Bethesda categories in the Indian population is limited. Objective As there are variations in the effectiveness of FNAC, this study aims to study the role of FNAC in evaluating thyroid nodules, estimating the risk of malignancy in thyroid nodules in the North-East Indian population, and correlating the FNAC findings with HPE (histopathological examination). Materials and Methods A total of 110 patients with thyroid nodules had visited the Department of Otorhinolaryngology during 2017–2020. Case records were retrieved, out of which only 66 patients had both FNAC and HPE reports. The FNAC of 66 patients were studied. Statistical Analysis Data were analyzed using STATA V14. Fischer's exact test was used to determine the association of Bethesda system in diagnosing thyroid malignancy. The percentage agreement between the FNAC and HPE was calculated using the Kappa statistics. The diagnostic validity of FNAC in the diagnosis of malignant thyroid nodule was reported. Results The sensitivity, specificity, PPV, and NPV of FNAC in diagnosing thyroid malignancy were 52%, 94.3%, 89%, and 69% respectively. The risk of malignancy (ROM) for Bethesda I to VI categories in our study was 20%, 25%, 67%, 40%, 78%, and 100% respectively (p-value < 0.001, Fischer's exact test). Conclusion A specificity of 94.3% and PPV of 89% of FNAC makes it a good reliable tool in ruling in malignancy in our population. The higher ROM in indeterminate categories necessitates the need to consider thyroidectomy with or without intraoperative frozen section analysis in our population. Similar higher ROM has been reported in a few other Indian studies. These findings may suggest an increased ROM for Bethesda categories III and IV in the Indian population; however, the statement needs further validation from large multicentric studies with research to find the reason for the increased risk.

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