Ahmed Al-Juboori1*, Abdalla Mirghani2 and Amira Nasser Al Hail3
1ENT Specialist, department of Surgery, Al Wakra Hospital, Hamad Medical Corporation, Doha, Qatar
2ENT Senior Consultant, Al Wakra Hospital, Hamad Medical Corporation, Qatar
3ENT Senior Consultant, Al Wakra Hospital, Hamad Medical Corporation, Qatar
Received: 04 March, 2017; Accepted: 17 April, 2017; Published: 18 April, 2017
Ahmed Al-juboori, Adjunct Assistant Professor, ENT Specialist, department of Surgery, Al Wakra Hospital, Hamad Medical Corporation, Doha, Qatar, Tel: 0097450210987; E-mail:
Al-Juboori A, MirghaniA, Al Hail AN. (2017) Unusual Route of Impaction, Hypopharyngeal non Penetrating Steel Shrapnel Foreign Body. Arch Otolaryngol Rhinol 3(2): 035-037. DOI: 10.17352/2455-1759.000041
© 2017 Al-Juboori A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Foreign body throat; Hypopharynx; Glide video laryngoscope
Foreign body injury is one of the most commonly encountered otorhinolaryngologic emergencies. The diagnosis and management of foreign bodies have mainly been based on the type and location of the foreign body. The workplace is a significant contributor to fatal and non-fatal injuries worldwide and an insufficiently appreciated contributor to the total burden of health care costs. Steel workers sustain a higher occupational hazard of penetrating injuries anywhere in the body, including the head and neck. However, we found no reports in the literature about non-penetrating shrapnel foreign body injuries, particularly in the upper aero-digestive tract. This is a case report of a twenty-five years old steelworker who presented to the emergency department in Al Wakra Hospital with a history of non-penetrating steel foreign body impaction in the throat which had been visualized by GlideScope and removed successfully with the assistance of Macintosh laryngoscope without complications. The purpose of this presentation is to highlight the unusual route taken by a shrapnel non-penetrating foreign body, through the open mouth to the hypopharynx. Also, probably this could be the first such case to be reported. A note has, also, been added about its visualization and method of removal, comparing two different techniques.
Foreign body ingestion is one of the most commonly encountered otorhinolaryngologic disorders, often requiring urgent decision making and management. In particular, it has been reported that children younger than 3 years exhibit the greatest risk of foreign body swallowing [1,2]. In adults foreign body ingestion occurs commonly, the majority of them pass spontaneously but some of them will impact at the hypopharyngeal level . The result may be severe due to possible ulceration or even perforation with consequent life threatening complications [4,5]. Many studies of foreign body injuries have focused on the case of young patients [2,6]. However it is also important to determine the frequency and characteristics of foreign body injuries in other age groups in addition to young children. Previous studies have demonstrated that some fatal cases occur in elderly patients due to foreign body asphyxia .
The diagnosis and management of foreign bodies have mainly been based on the type and location of the foreign body. Therefore, clinical information on the type and location of foreign bodies can expedite the management of these patients . The workplace is a significant contributor to fatal and non-fatal injuries worldwide and an insufficiently appreciated contributor to the total burden of health care costs, like the occupational hazards of steel workers who manifest with penetrating injuries anywhere in the body . However there are no reported non penetrating injuries of steel worker foreign body injuries particularly in the upper aerodigestive tract.
The aim of the presentation of this case report is to highlight the route of a non-penetrating steel foreign body in the hypopharynx in a steelworker, and probably this could be the first reported case of this unusual route of entry.
A twenty-five-years-old steelworker presented to the emergency department in Al Wakra Hospital with a history of foreign body impaction in the throat during work. When one of his colleagues was hammering steel nearby him, he felt something entering through his mouth, when it was open and getting inserted inside the throat. He was complaining of odynophagia, dysphagia with progressive change of voice. On examination, the patient was conscious, afebrile, not in respiratory distress and hemodynamically stable. Complete ear, nose and throat examination was normal, apart from a small wound at the tip of the tongue. Neck examination showed no evidence of external wounds or subcutaneous surgical emphysema but there was mild tenderness over the right side of the neck. flexible nasolaryngoscopy done under local anesthesia showed impacted foreign body (metal) on the right side of the supraglottic area with edema of the surrounding area of the epiglottis, aryepiglottic fold, arytenoids and part of the vocal fold on the right side. Plain x-ray of the neck, anteroposterior and lateral views, showed evidence of a metallic radio-opaque foreign body at the level of the fourth cervical vertebra directed towards the right side (Figure 1).
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