Abstract
Sore throat, hoarseness, and dysphagia are known and recognized postoperative complications of laryngeal mask airway use during operative procedures. The patient’s symptoms, present immediately after surgery, are thought related to airway manipulation. Airway foreign bodies, although low on the differential, can cause similar symptoms. We present a case of a single patient who presented to a tertiary care center after an elective outpatient procedure with postoperative sore throat, hoarseness, and dysphagia. A foreign body was found lodged in the patient’s hypopharynx. The differential diagnosis of sore throat, hoarseness, and dysphagia in the postoperative patient is explored in further detail.
1
Introduction
The laryngeal mask airway (LMA) was developed by British anesthesiologist Archie Brain in the 1980s and has been available to American anesthesiologists since 1992. With a greater than 99% success rate , the LMA has proven to be safe and effective, even in difficult airway situations . Sore throat, hoarseness, and dysphagia are well known and recognized postoperative complications from LMA use. When these symptoms persist or worsen outside of the immediate perioperative period, alternative diagnoses, like airway foreign bodies, should be considered.
2
Case report
Institutional review board (IRB) approval was obtained from the Duke University School of Medicine; the requirement for written consent given the retrospective nature was waived. The patient was a 61-year-old male who underwent an elective right knee arthroscopy two days prior to arrival. Upon emergence from anesthesia, he noted a sore throat, globus sensation and odynophagia. He discussed his concerns with his anesthesiologist, who informed the patient that placement of the LMA was difficult, requiring removal and reinsertion. The patient was reassured and given chloroseptic spray. Over the next 48 hours, he developed worsening globus, hoarseness, odynophagia, and dysphagia to solids. He denied respiratory distress, fever, chills, palpitations, and chest pain. He presented to the emergency department at a tertiary referral center for evaluation. The vital signs were within normal limits; he was not stridulous or in respiratory distress. His neck was flat and without crepitus. Upon flexible fiberoptic laryngoscopy, the true vocal folds were fully mobile without evidence of arytenoid dislocation but an opaque circular foreign body was noted within the hypopharynx overlying the arytenoids and contacting the lateral borders of the epiglottis. Attempts at bedside removal with Magill forceps under fiberoptic guidance were unsuccessful. The patient was taken to the operating room for a direct laryngoscopy with removal of the foreign body. An electrocardiogram lead electrode backing was removed from the hypopharynx without incident (see Fig. 1 ). Direct examination afterwards revealed erosion of the posterior pharyngeal wall and edema of the arytenoids. The patient noted immediate resolution of the globus sensation, dysphagia, and hoarseness after removal of the foreign body. He maintained a mild sore throat. The patient was given a 10 day course of prednisone and amoxicillin/clavulanate and was discharged to home in stable condition. There was no long term sequela noted on follow-up.
