Peculiar penetrating oropharyngeal foreign body accident: a case report and review of literatures

Abstract

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 Due to the hook shape, it had to be withdrawn cephalad for removal.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.