AlBilasi Thamer M, AlDhawi Lama F, AlOlaywi Ahmed N, Al Mutairy Alyaa S, AlGhamdi Fareed R, Alamry Saleh S, AlZhrani Hatem A
Department of Otolaryngology - Head and Neck Surgery, Prince Sultan Military Medical City, Riyadh, SAU.
Collage of Medicine, AlMaarefa University, Riyadh, SAU.
Cureus. 2023 Jun 15;15(6):e40462. doi: 10.7759/cureus.40462. eCollection 2023 Jun.
Ingested foreign objects that become trapped in the upper aerodigestive tract is a common issue that arises in Otolaryngology-Head and Neck Surgery practice. In these circumstances, it is advised to explore the neck using an external method to remove the item. However, locating the foreign body might be challenging. Not all metallic foreign body (MFB) patients require surgery, especially those without symptoms or complications. The standard X-ray and CT images are routinely examined for preoperative assessment and localization. Removal can be accomplished via flexible pharyngo-laryngoscopy or upper gastrointestinal endoscopy. Fluoroscopy is a widely accessible, minimally invasive, but underutilized tool during procedures. It offers an accurate intraoperative assessment of the foreign body in real-time. To allow the planning of a secure extraction pathway, the target should be radiopaque. In this report, we present three unique cases in which we used fluoroscopic imaging for guidance to remove a foreign body in the head and neck region in Prince Sultan Military Medical City in Riyadh, Saudi Arabia. In the first case, a young male presented with a history of foreign body sensation and odynophagia in the throat after eating a (shawarma) sandwich. In the second case, a six-year-old boy presented to the emergency department (ED) with epistaxis after being exposed to an air gun shot to his face. In the third case, a 40- year-old male presented after exposure to an air gun shot to the neck. After identification of the foreign body, all three patients were referred to Otolaryngology-Head and Neck. After radiological images have been done to confirm the presence of foreign objects, all three had a minimally invasive procedure to remove the metallic foreign bodies under fluoroscopic guidance without needing extensive surgery. All the procedures went well with no immediate complications with discharge on the same day. Fluoroscopy-guided removal of foreign bodies related to metabolic forging is a promising technique with several advantages, including real-time visualization, reduced invasiveness, and shorter recovery times. However, it is essential to weigh the benefits against the risks associated with radiation exposure and inherent limitations in detecting non-metallic objects. Further research and clinical studies are needed to optimize this technique and establish evidence-based guidelines for its application in the field of metabolic forging bodies.
摄入的异物被困在上呼吸道消化道是耳鼻咽喉头颈外科临床中常见的问题。在这种情况下，建议采用外部方法探查颈部以取出异物。然而，定位异物可能具有挑战性。并非所有金属异物（MFB）患者都需要手术，尤其是那些没有症状或并发症的患者。术前评估和定位通常会常规检查标准X线和CT图像。可通过软性咽喉镜检查或上消化道内镜检查来取出异物。荧光透视检查是一种在操作过程中广泛可用、微创但未得到充分利用的工具。它能在术中实时准确评估异物情况。为了规划安全的取出路径，目标异物应是不透射线的。在本报告中，我们介绍了三例独特病例，在沙特阿拉伯利雅得的苏丹王子军事医疗城，我们使用荧光透视成像引导取出头颈部区域的异物。第一例中，一名年轻男性在食用（沙瓦玛）三明治后出现喉咙有异物感和吞咽痛的病史。第二例中，一名6岁男孩因面部被气枪射击后到急诊科就诊，伴有鼻出血。第三例中，一名40岁男性在颈部被气枪射击后前来就诊。确定异物后，所有三名患者均被转诊至耳鼻咽喉头颈外科。在完成放射影像检查以确认异物存在后，所有三例均在荧光透视引导下进行了微创手术以取出金属异物，无需进行广泛手术。所有手术均顺利进行，无即刻并发症，患者于同日出院。荧光透视引导下取出与气枪射击相关的异物是一项有前景的技术，具有多种优势，包括实时可视化、侵入性降低和恢复时间缩短。然而，必须权衡其益处与辐射暴露相关风险以及检测非金属物体时的固有局限性。需要进一步的研究和临床研究来优化该技术，并为其在气枪射击异物领域的应用建立循证指南。
