Fluoroscopy-Guided Metallic Foreign Body Removal: A Report of Three Cases and Literature Review

Abstract

Ingested foreign objects that become trapped in the upper aerodigestive tract is a common issue that arises in Otolaryngology-Head and Neck Surgery practice. In these circumstances, it is advised to explore the neck using an external method to remove the item. However, locating the foreign body might be challenging. Not all metallic foreign body (MFB) patients require surgery, especially those without symptoms or complications. The standard X-ray and CT images are routinely examined for preoperative assessment and localization. Removal can be accomplished via flexible pharyngo-laryngoscopy or upper gastrointestinal endoscopy. Fluoroscopy is a widely accessible, minimally invasive, but underutilized tool during procedures. It offers an accurate intraoperative assessment of the foreign body in real-time. To allow the planning of a secure extraction pathway, the target should be radiopaque. In this report, we present three unique cases in which we used fluoroscopic imaging for guidance to remove a foreign body in the head and neck region in Prince Sultan Military Medical City in Riyadh, Saudi Arabia. In the first case, a young male presented with a history of foreign body sensation and odynophagia in the throat after eating a (shawarma) sandwich. In the second case, a six-year-old boy presented to the emergency department (ED) with epistaxis after being exposed to an air gun shot to his face. In the third case, a 40- year-old male presented after exposure to an air gun shot to the neck. After identification of the foreign body, all three patients were referred to Otolaryngology-Head and Neck. After radiological images have been done to confirm the presence of foreign objects, all three had a minimally invasive procedure to remove the metallic foreign bodies under fluoroscopic guidance without needing extensive surgery. All the procedures went well with no immediate complications with discharge on the same day. Fluoroscopy-guided removal of foreign bodies related to metabolic forging is a promising technique with several advantages, including real-time visualization, reduced invasiveness, and shorter recovery times. However, it is essential to weigh the benefits against the risks associated with radiation exposure and inherent limitations in detecting non-metallic objects. Further research and clinical studies are needed to optimize this technique and establish evidence-based guidelines for its application in the field of metabolic forging bodies.

Decade Later Presentation of an Intraosseous Metallic Foreign Body in the Pelvis: A Case Report and Literature Review

“…At times, small foreign bodies may present with serious symptoms, while large ones may remain dormant for many years [ 3 , 9 , 10 ]. In the presentation of multiple retained foreign bodies in the same patient, some of them may be symptomatic while others may remain dormant.…”

Ultrasound-Assisted Removal of a Wooden Foreign Body Embedded in the Neck

“…The US has been successfully used by various authors to pinpoint the FB and to preserve vessels and other anatomical structures, thus decreasing the rate of perioperative complications to confirm the complete removal of the FB and minimize the length of the cervical incision, thus corresponding to the aesthetic sequelae of an open approach [27,31,32]. Other authors opted for a percutaneous fluoroscopically guided localization of the extraluminally migrated FB that allowed the real-time assessment of the FB, a lower rate of postoperative complications, and a shorter hospital stay [16,[33][34][35]. Finally, Wu et al used CT-guided neck navigation to identify the exact site of where to incise the pharyngeal mucosa for chicken bone extraction [36].…”