A foreign body embedded in the mobile tongue masquerading as a neoplasm

Foreign bodies in a mobile tongue are rarely presented to the laryngologist, because such bodies are commonly lodged superficially and are easily removed by the patients themselves or by general practitioners. Thus, it is rare that a foreign body totally embedded in the mobile part of the tongue presents as an enlarged tongue mass. We have described a 64-year-old female with a 3-month history of an enlarged mass in the anterior right tongue. Physical examination showed a mass located in the anterior right tongue, with intact mucosa and normal color. A benign tongue neoplasm was considered first. However, a fish bone totally embedded in the mobile tongue with granuloma formation was encountered during the incisional biopsy operation. Complete removal of the foreign body with granuloma was achieved under local anesthesia. There was no neuromuscular or neurosensory deficit of the tongue in the follow-up period of 2 years. Although an embedded foreign body in the mobile tongue is a rare condition, it should be considered in the work-up of a patient with an enlarged tongue mass, with or without a history of swallowing a foreign body.     

Asymptomatic near-total airway obstruction by a cylindrical tracheal foreign body

OBJECTIVES/ HYPOTHESIS: The objective was to present the unique case of previously unreported asymptomatic cylindrical tracheal foreign body causing near-total airway obstruction. The asymptomatic nature of the case made diagnosis and management challenging. STUDY DESIGN: A retrospective case review at an urban health maintenance organization medical center. METHODS: A 3.5-year-old asymptomatic boy was incidentally discovered to have a metallic foreign body in his mid trachea on a screening scoliosis roentgenogram. He underwent rigid bronchoscopic retrieval the following day. RESULTS: The foreign body was found to be a corroded, 9 x 6-mm metallic cylinder with a narrowed luminal diameter of 2.0 mm. Intubation was maintained in the pediatric intensive care unit for 48 hours, and extubation was performed in the operating room under direct bronchoscopy. Mitomycin C was applied to a circumferential area of denuded tracheal mucosa. CONCLUSION: Tracheal foreign bodies are distinctly different clinical entities from bronchial foreign bodies. Asymptomatic bronchial foreign bodies are relatively common, but to the authors' knowledge, an asymptomatic tracheal foreign body had not been reported previously. Discussion focused on pathophysiology with reference to Poiseuille's law, diagnosis, and management of asymptomatic tracheal foreign bodies, including the possibility of elective bronchoscopic retrieval.     

Don't hang your coat here

Report 2 cases of coat hanger floor of mouth injuries in children. We describe 2 cases of children who presented with coat hanger impalement injuries of the floor of mouth and their management. Removal under anesthesia is safe with a period of observation postoperatively. Impalement injury with coat hangers in the head and neck is a rarely encountered or described mechanism of trauma. We report the first case series of coat hanger impalement injuries in the floor of mouth in two children. Plain film radiographs may be useful to determine the depth of injury and trajectory of the foreign body. Careful removal under anesthesia is safe. Little if any floor of mouth edema was encountered postoperatively, but close observation for potential critical floor of mouth hematoma or edema should be considered.     

Neonatal dermoid cyst of the floor of the mouth extending to the midline neck.

We describe a male neonate who presented at birth with a compressible dermoid cyst that extended from the floor of the mouth to the midline of the neck. Ultrasonography revealed a fluid-filled sublingual mass. Magnetic resonance imaging performed when the patient was 1 week old demonstrated a 2-cm, cystic, left-sided, sublingual mass that crossed the midline without extension inferior to the mylohyoid muscle. At 3 months of age, the patient developed a 1-cm, solid, submental mass. At the time of surgery, the lesion had a fibromembranous tract that extended through the myolohyoid muscle to a 1-cm cyst in the submental region. Histologic sections depicted 2 dermoid cysts and a connecting fistula. This case represents the first report (to our knowledge) of a dermoid cyst presenting in a neonate as a mass in the floor of the mouth with extension to the midline of the neck.     

Migrating pharyngeal foreign bodies: a series of four cases of saw-toothed fish bones

Pharyngeal foreign bodies are common problems seen at emergency rooms or ENT outpatient clinics, and fish bones are the most common foreign bodies encountered in East Asia and in Korea. One of the rare complications of a swallowed sharp fish bone is its migration from the site of entry into the subcutaneous tissues of the neck. We present four unusual cases of ingested fish bones that migrated out of the upper digestive tract to the neck. In the first case, this caused a recurrent deep neck infection for 2 years; in the second case, there was penetration of the facial artery; in the third case, there was a hematoma of the floor of the mouth; in the fourth case, there was a retropharyngeal abscess.     

An unusual sharp magnetic foreign body in the oesophagus and its removal: A case report

Ingestion of foreign bodies is a common pediatric problem. The majority of ingested foreign bodies pass spontaneously. Oesophageal foreign bodies should be urgently removed because of their potential to cause complications. Ingested batteries that lodge in the oesophagus, sharp or pointed foreign bodies in the oesophageal or gastric tract, and ingestion of multiple magnets all require urgent endoscopic removal. A 4-year-old boy ingested a sharp magnetic foreign body, which was removed via rigid oesophagoscopy without complication. To the best of our knowledge, this is the only sharp magnetic foreign body ingested by a young child ever reported in the English-language literature. We describe the presentation and therapeutic procedure adopted in this case.     

Unusual complication of an ingested foreign body

Migration of a foreign body from the mouth and throat to the subcutaneous tissue of the neck is very rare. We present a case of a migrating foreign body (a piece of straw) from the floor of the mouth to the neck. To our knowledge, this is the second case reported in the English literature.     

Delayed diagnosis of a pediatric airway foreign body: case report and review of the literature

Foreign body aspiration is a common pediatric problem that affects children of all ages, including those who are well into their adolescence. We describe the case of a 9-year old boy with an airway foreign body that had gone unrecognized for 3 months. We also review the literature on pediatric airway foreign bodies, with a focus on delayed diagnosis. A diagnosis of foreign body aspiration should be considered whenever a previously healthy child suddenly exhibits unexplained symptoms that are refractory to medical treatment and are consistent with airway obstruction.     

The origin of bronchial foreign bodies: a retrospective study and literature review

Nasal foreign bodies are managed as an emergency for the risk of aspiration, yet it is not clear what proportion of bronchial foreign bodies actually originate in the nose. The aim of this study was to identify the origin of bronchial foreign bodies and estimate the risk of a nasal foreign body becoming impacted in the bronchial tree. We present a retrospective study of suspected bronchial foreign body cases at Addenbrooke’s Hospital in Cambridge, UK, who underwent a bronchoscopy between 2002 and 2007. We further compare our experience with a literature review on bronchial and nasal foreign bodies to highlight important differences between these distinct clinical problems. Our experience shows that all cases of proven foreign body at bronchoscopy had ingested the foreign body orally. We could find only one case of a nasal foreign body in the literature that had been ingested during its removal, but no cases specifically entering the tracheo-bronchial tree. We therefore conclude that bronchial foreign bodies have their origin almost invariably in the mouth and the risk of a nasal foreign body entering the bronchial tree is negligible (<0.06%).     

An unusual foreign body of the tongue masquerading as malignancy

Foreign bodies within the tongue are a rare finding. The history is often not helpful as it is usually remote. Presented is a case of an unusual foreign body in the tongue which masqueraded as a malignancy. The differential diagnosis of an asymptomatic tongue swelling or tongue pain should include foreign body.     

Gastric heterotopia in the nasopharynx

Heterotopic gastrointestinal mucosa is rare in head and neck area. Most cases are described in oral cavity especially in the floor of the mouth. We present herein the case of an 8-month old infant with a tumor-like mass in the cavum which consisted of an heterotopic gastric mucosa. This case is the first described in this localisation. A brief review of the literature and histopathologic differential diagnoses will be study.     

Migratory pharyngeal foreign bodies and related complications: Analysis of 20 cases

PurposeTo explore the diagnostic approach and therapeutic method of migratory pharyngeal foreign bodies and related complications, to improve the understanding of such disease and to reduce misdiagnosis and missed diagnosis.Material and methodsA retrospective study was performed by collecting patients who were treated because of the related complications caused by migratory pharyngeal foreign bodies from 2012 to 2020.ResultsA total of 20 patients were admitted to hospital due to the related complications. 14 cases showed cervical mass; 3 cases showed abscess of the mouth floor; 1 cases showed retropharyngeal abscess; 1 cases showed laryngeal granuloma; 1 cases showed mass of tongue. All patients received imaging examination of B-ultrasonography or computed tomography (CT). 19 patients were treated by surgery, and 1 patient was taken conservative treatment. All foreign bodies was successfully removed. As for the type of foreign bodies, there have 15 cases of fishbone, 2 cases of crabshell, 2 cases of shrimp shell, 1 cases of duck bone.ConclusionsMigrating foreign bodies and related complications are rare in clinic, much attention should be paid to avoid missed diagnosis or misdiagnosis.     

Lateral dermoid cyst of the floor of mouth: unusual radiologic and pathologic findings

A lateral dermoid cyst is a rare lesion of the floor of mouth, with only 12 cases reported in the literature. We describe the case of a 60-year-old man with a slowly enlarging mass in the submandibular region. Magnetic resonance imaging demonstrated a lesion containing multiple uniformly rounded foci, creating a “sack-of-marbles” appearance. Needle aspirations showed atypical findings, and the mass was excised. Histopathology revealed a cyst containing a keratinizing stratified squamous epithelial lining with apocrine and eccrine glands. These findings were diagnostic of a dermoid cyst, which should be considered in the differential diagnosis of any midline or lateral cervical lesion.     

Midline sublingual dermoid cyst

The case of an 18-year-old man who presented with a large cystic mass in the floor of the mouth extending into the left submandibular triangle of the neck is reported. Histopathology of this mass, which was totally excised by a combined intra-oral and cervical approach, confirmed it to have originated in ectodermal remnants (congenital dermoid cyst) and to be actively secreting sebum. This case is reported both because dermoids at this site are rare because they may present some problems in management.     

Lobular capillary hemangioma on the floor of the mouth (pyogenic granuloma). Report of a case and literature review

Lobular capillary hemangioma or pyogenic granuloma is a benign lesion with a focal reactive development of fibrovascular tissue and endotelial proliferation. It can appear to any age in different locations and usually has the aspect of a pediculate mass with or without ulceration zones on the area. Its treatment is the simple surgical removal and the control of the traumatic and infectious influential factors. We report a case of pyogenic granuloma on the floor of the mouth making a literature review at respect of that common clinical entity.     

A prolonged buried fish bone mimicking Ludwig angina

Most migrated foreign bodies in the neck were removed immediately in patients with persistent symptoms. It is a rare condition that a fish bone was buried for a prolonged time in the tongue with little discomfort. We report a unique case of an ingested fish bone lodged in the tongue for 16 months until infection ensued. Ludwig angina was considered first because the patient had fever, odynophagia, swelling of the tongue, and mouth floor. The fish bone buried in the tongue was incidentally found on the computed tomography scan and successfully removed by surgical exploration. Although dental infection is the most common underlying cause in Ludwig angina, embedded foreign body should be considered as one of the pathogenesis. On the other hand, computed tomography scan can be useful in identifying extraluminal migration of fish bones in the neck.     

经口吹气治疗幼儿鼻腔异物45例疗效分析

目的 探讨经口吹气取鼻腔异物的临床实践,为临床提供参考。 方法 回顾性分析2013年4月~2015年5月诊治的125 例儿童鼻腔异物的临床资料,分析两种治疗方法的有效性及安全性。 结果 经口吹气组45例患者中有6例患儿异形硬质异物、瓜子未取出(后通过其他有创方式取出),其余异物均顺利取出,无一例患儿出现鼻黏膜出血、鼻腔损伤及异物后坠等风险;使用鼻腔异物钩、枪状镊等器械组85例患者中1例患儿在取异物过程中发生异物后坠,后经检查坠入支气管内经全麻手术取出;5例患儿鼻腔表面麻醉后仍不能配合,后改为全麻下取出。由于患儿配合情况不同,出现不同程度鼻黏膜损伤致鼻腔少量出血者7例,鼻出血较严重经压迫止血者1例。 结论 经口吹气是针对婴幼儿的一种简单、有效、无损伤的取鼻腔异物方法,尤其是对表面光滑、无明显棱角的异物效果确切,值得临床推荐。     

Dermoid cyst of the floor of the mouth

Dermoid cysts are congenital lesions composed of tissues with different origins: ectoblastic, mesoblastic, or endoblastic, caused by a defect in the fusion of the embryonic lateral mesenchymatic mass. A true dermoid cyst is a cavity covered with epithelium showing keratinisation and presenting identifiable dermal appendices. We present a case of a male patient aged 53 years presenting tumouration on the floor of the mouth with an evolution of about 30 years. A bibliographic revision of this pathology is also presented.     

Plastic laryngeal foreign bodies in children: a diagnostic challenge

OBJECTIVE: To review Children's Hospital and Regional Medical Center experience with pediatric airway foreign bodies, and examine the incidence and treatment of laryngeal foreign bodies. To determine if plastic laryngeal foreign bodies present differently than other laryngeal foreign bodies. METHODS: A retrospective review of all cases of children (1874 patients) undergoing direct laryngoscopy and/or bronchoscopy from 1st January 1997 to 9th September 2003 at a tertiary care children's hospital. Patients with endoscopically documented laryngeal foreign bodies were identified and the medical record reviewed in more detail. Patient age, gender, foreign body location, foreign body type, duration of foreign body presence, radiographic findings, endoscopic findings and treatment complications were recorded. RESULTS: One hundred and five aspirated foreign bodies were identified. The nine laryngeal foreign bodies included five clear plastic radiolucent items, two radiolucent food items, and two sharp radioopaque pins. Time to diagnosis and treatment was on average 11.6 days with 17.6 days for thin/plastic foreign bodies and 1.6 days for metal/food foreign bodies. CONCLUSION: Laryngeal foreign bodies represent a small portion of all pediatric airway foreign bodies. Difficulty in identifying laryngeal foreign bodies, especially thin, plastic radiolucent foreign bodies can delay treatment. Thin plastic foreign bodies can present without radiographic findings, can be difficult to image during endoscopy and can be particularly difficult to diagnose. A history of choking and vocal changes is associated with laryngeal foreign bodies. Laryngeal foreign bodies should be in the differential diagnosis of all children presenting with atypical upper respiratory complaints especially if a history suggestive of witnessed aspiration and dysphonia can be obtained.     

A prospective study of foreign-body ingestion in 311 children

OBJECTIVE: To determine the preferable management protocol of foreign body ingestion in pediatric patients. METHODS: All pediatric patients aged less than 12 years who presented with suspected foreign body ingestion in a hospital setting over a period of 3 years were prospectively studied. The usefulness of symptoms and various diagnostic procedures to identify the impacted foreign bodies were analyzed. RESULTS: Of 311 children aged 4 months to 12 years, 115 foreign bodies were encountered. The presentations in children aged younger than 5 years were markedly different from the older children, who behaved more like adults. All sharp foreign bodies (107 cases or 93%), mostly fish bones (90.4%), were found in the oropharynx under direct vision using either tongue depressor (57%), Macintosh laryngoscope (6%), indirect laryngeal mirror (2%) or transnasal flexible endoscopy (28%). Coins (eight cases or 7%) were the only foreign body impacted at or below the level of cricopharyngeus. A plain cervical X-ray has a low sensitivity (15.9%) and a high specificity (99.5%) in identifying the foreign bodies. CONCLUSIONS: As the majority of the foreign bodies were sharp bones and situated in the oropharynx, a management protocol involving examination with a tongue depressor, transnasal laryngoscope, selective lateral soft tissue neck X-ray, chest X-ray and watchful observation is usually adequate. Removal of these foreign bodies can be accomplished using a tongue depressor and Macintosh laryngoscope. Patients with a suspected coin ingestion have to be evaluated by X-ray, and a rigid pharyngo-oesophagoscopy should be the mainstay of treatment.