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R. VINEY and A. REID
Worcester Royal Infirmary, Ronkswood Branch, Newton Road, Worcester, WR5 1HN, U.K.
J.R.Coll.Surg.Edinb., 47; 2: 515
We present a novel approach for a common ENT emergency. Under nasendoscopic guidance, a fishbone lodged in the pharynx can be removed with a suction catheter passed nasally
Keywords: fishbone, extraction
A fishbone lodged in the laryngopharynx is a common problem encountered in an emergency ENT clinic setting. Over twelve months, the ENT department at the University Trust Hospital at Birmingham dealt with 75 cases of impacted foreign bodies in the aerodigestive tract, of which 35% were fishbones.
The diagnosis is usually made with indirect laryngoscopy or flexible nasendoscopy (the value of plain radiography has long been debated), and once the offending object has been located, a strategy for its removal is formulated.1 This usually involves direct procedures via the buccal cavity (75% of interventions). 2 Alternative approaches include nasendoscopy with a biopsy forcep (15% of interventions) (or nasendoscopic assistance of a per oral procedure).3 Recently two patients were encountered who would simply not tolerate instrumentation of their buccal cavities. The patients tolerated nasendoscopy and, in both instances, a fishbone was identified at the base of the lingual tonsil. Without access to a nasendoscope with a biopsy forcep, the fishbones were removed with the use of a suction catheter passed down the other nostril. The catheter tip was manoeuvred into position against the posterior oropharyngeal wall behind the bone under nasendo-scopic vision. The patients were then asked to swallow. In swallowing, the lingual tonsil moves back against the posterior oropharyngeal wall, bringing the bone to the awaiting catheter. On both occasions the bone was swiftly and safely removed. This technique is worth considering in patients who cannot tolerate per-oral procedures for the removal of pharyngeal foreign bodies.
Figure 1: Nasendoscopic view of a suction catheter in place against the posterior pharyngeal wall
1. Braverman I, Rosenmann E. Value of radiography
in the management of possible fishbone ingestion
Ann Otol Rhinol Laryngol 1995; Jun 104(6):501
2. Choy CB, Van Hasselt CA. Flexible
nasopharyngoscopy for fishbone removal from
the pharynx J Laryngol Otol 1992; Aug
106(8):709-11
3. Koay CB, Herdman RC. Nasendoscopy guided
removal of fishbones from the base of the
tongue and vallecula J Laryngol Otol 1995; Jun
109(6)534-5
Copyright: 1 December 2001
Correspondence: Mr R Viney, Worcester Royal Infirmary, Ronkswood Branch, Newton Road, Worcester, WR5 1HN, U.K.