Dorsal flexion of head and neck for rigid oesophagoscopy--a caution for hidden foreign bodies dropped into the epipharynx.

A 32-month-old girl presented with a swallowed coin in the mid-oesophagus verified by chest radiography. Rigid oesophagoscopy was performed under general anaesthesia with muscle paralysis and tracheal intubation with dorsal flexion of the head and neck. The coin could be grasped using 'optical forceps'. When the oesophagoscope-forceps assembly was removed, the coin had disappeared. Repeated explorations of the oesophagus including direct laryngoscopy were unsuccessful. A further direct laryngoscopy, while placing the head in the neutral position, revealed the coin just dislodging from the epipharyngeal space in the hypopharynx, from where it was removed with a Magill forceps (Arnold Bott, Glattbrugg, Switzerland). Dorsal flexion of the head and neck during foreign body removal may allow entry of the foreign body or easily fragmented foreign bodies into the epipharyngeal cavity. Exploration is recommend using naso-pharyngeal suction and direct laryngoscopy with the head in the neutral position before tracheal extubation in order to avoid acute airway obstruction.