A foreign body lodged in the sub-mental space through to the retro-pharyngeal area: a review of anatomical risks and surgical approaches

• Published in: The Egyptian journal of otolaryngology Vol. 37; no. 1; pp. 120 - 6
• Main Authors: Cherrabi, Kaoutar, Zaki, Zouheir, El Alami, Mohamed Noureddine
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.12.2021; Springer; Springer Nature B.V; SpringerOpen
• Subjects: Carotid arteries; Case Report; Cervical; Dissection; Esophagus; Foreign bodies; Foreign body; Head and neck; Open wounds; Infections; Injuries; Medical imaging; Medicine; Medicine & Public Health; Mortality; Neck; Ostomy; Patients; Sub-mandibular; Sub-mental; Surgery; Trauma; Veins & arteries; Foreign body; Sub-mental; Sub-mandibular; Head and neck; Open wounds; Cervical
• ISSN: 1012-5574; 2090-8539
• DOI: 10.1186/s43163-021-00184-9

Background Foreign body inclusions are rare in head and neck. They are challenging in regard to anatomical risks and surgical approaches. This is the case of a particular foreign body with a curious trajectory, associated with a brief review of anatomical risks and surgical approaches. Case presentation This is the case of a 25-year-old male who has been attacked with a sharp object, which caused an inclusion of a part of the foreign body in the sub-mental and pharyngeal areas. The clinical exam showed a painful bulging in the sub-mental area, with moderately hemorrhagic sputum and difficulty while swallowing. The intra-oral exam showed a foreign body that was located at the right side of the base of the tongue, and which goes backwards and outwards to penetrate retro-pharyngeal mucosa. The patients underwent an angio-CT scan, which showed a curious fine and sharp metallic object, without direct signs of lesions to the jugular vein or carotid artery or any collateral branches. The patient underwent extraction through cervical approach, with satisfying bleeding control. Intra-oral exploration showed a retro-pharyngeal lesion of 2 cm, without particular bleeding. The cervical lesion and retro-pharyngeal lesions were closed. The lesion at the base of the tongue was of 1 cm, palpable but not accessible to sutures, and a naso-pharyngeal tube was inserted. The patient presented very satisfying post-operative outcome, without any complications. Conclusion When dealing with foreign bodies of head and neck, physicians must be precocious and prepared for the risk of bleeding after extraction. Thorough radiological exploration is necessary as long as the patient is stable. Direct and indirect radiological signs allow the clinician to understand the nature and the trajectory of the object, as well as the damage to collateral structures.