Abstract
Objectives
To report a small case series of an unusual ingested foreign body and a new method for removal of tongue base foreign bodies.
Methods
Three patients were identified with wire bristle foreign bodies between 2009 and 2011 at our academic tertiary medical center. Their medical records were reviewed and are described in this report.
Results
Each patient presented to our medical center with progressive pain after ingestion of barbecued food. For 2 patients, the metallic bristle foreign body was imbedded within the lingual tonsil. In these 2 cases, radiofrequency plasma ablation (coblation) assisted partial lingual tonsillectomy was performed to identify the foreign body. In a third case, the foreign body presented as a complex deep space neck abscess and an open trans-cervical approach was required.
Conclusion
While oropharyngeal and esophageal foreign bodies are common, there are only a few case reports describing this particular foreign body. The presentation of an imbedded wire grill brush bristle can be insidious. Persistent pain and foreign body sensation should be taken seriously in patients with a history of barbecue food ingestion. Intraoperatively, wire bristles can be difficult to localize and extract. Radiofrequency plasma assisted lingual tonsillectomy may be helpful for identifying and removing foreign bodies that are imbedded in the tongue base. Grill brushes should undergo stringent safety regulation, as ingested wire bristles are difficult to localize and remove and may cause significant morbidity.
1
Introduction
Ingested foreign bodies are frequently encountered in the adult and pediatric populations. While many of our tools are similar to those used a century ago, otolaryngologists now have additional instruments in their armamentarium. The morbidity of ingested foreign bodies can be significant, and new instruments, such as the radiofrequency plasma ablation device, increase the feasibility and safety of extraction.
Ingested foreign bodies are unfortunately a frequently encountered phenomenon in Otolaryngology. Oropharyngeal or upper esophageal wire bristles have been described in a small number of case reports . A recent series of two patients described wire bristles in children, specifically located in the base of tongue and in the vallecula. Each was removed under microlaryngoscopy using an alligator forceps . In an additional case report, the patient presented with a lingual abscess . The wire bristle in this case could not be retrieved and was left behind, without further sequelae. The first ever report of an ingested wire bristle was in 1952, which resulted in esophageal perforation .
This foreign body presents insidiously and is difficult to extract, resulting in significant patient morbidity. In each case ever reported, patients required multiple surgical procedures. This report discusses wire bristle oropharyngeal and esophageal foreign body removal, as well as a new technique for extraction using a radiofrequency plasma ablation device.
3
Case reports
3.1
Case 1
A 43-year-old woman with a medical history of asthma and hypertension presented with progressive neck and back pain. She was initially treated at an outside hospital. At that institution, she underwent a computed tomography (CT) scan that demonstrated a neck mass, with possibly a foreign body reaction surrounding a radio-opaque object. Upper esophageal endoscopy was performed, but no lesion or object was found. She was subsequently transferred to our hospital for further evaluation and management. Neck exploration was performed, during which a linear metallic object was discovered in the parapharyngeal space at the level of the cricoid cartilage. The foreign body was removed and was consistent with a metal wire brush bristle. A significant amount of pus was evacuated and sent for culture. The wound was thoroughly irrigated and closed, leaving a penrose drain for 24 hours. Ultimately, she recovered completely.
3.2
Case 2
A 12-year-old girl presented to our medical center with odynophagia and foreign body sensation after eating at a barbeque. A CT scan of the neck demonstrated a linear radio-opaque foreign body at the level of the base of tongue ( Fig. 1 ). Direct laryngoscopy and rigid esophagoscopy were performed. The wire bristle was identified and briefly grasped, but was subsequently lost in the base of tongue tissue. Intraoperative fluoroscopy also failed to identify the object. Postoperatively, a second CT scan was performed, revealing a persistent radio-opaque foreign body deeper within the lingual tonsil ( Fig. 2 ). Once again, the patient was brought to the operating room. The child underwent partial lingual tonsillectomy using a radiofrequency plasma ablation device (Coblator, Arthrocare, Sunnyvale, CA), as described by Koltai et al . The patient was nasotracheally intubated, and a tongue suture was placed to retract the tongue anteriorly. Two red rubber catheters were inserted into the nares and secured with a clamp for retraction of the soft palate anteriorly. With the surgeon at the head of the bed, a 70°-angled endoscope was used to visualize the base of tongue transorally. The radio frequency plasma ablation device was used to carefully dissect through the lingual tonsil. The metallic foreign body was uncovered from within the substance of the lingual tonsil and removed. Symptoms resolved following surgery.
