Kosin Med J.  2023 Jun;38(2):151-155. 10.7180/kmj.22.141.

A case report of a carotid space abscess due to extraluminal migration of a fishbone into the deep cervical space

• Lee TH
• Cho KJ
• Won SJ
• Park JJ

• KMID: 2543336
• DOI: http://doi.org/10.7180/kmj.22.141

Abstract

Laryngopharyngeal foreign bodies are among the cases most frequently encountered by otolaryngologists. Most foreign bodies can be easily removed without any complications. However, surgical removal is required in some cases. Therefore, a delayed diagnosis or misdiagnosis could cause fatal complications for patients who need a surgical approach. We report a rare case of extraluminal migration of a foreign body to the deep cervical space. The foreign body (a fishbone) was removed by a surgical approach. With a literature review, we also propose an algorithm for the management of suspicious foreign bodies in the neck.

Keyword

Carotid space; Case reports; Deep neck infection; Surgical removal; Extraluminal migration; Ingestion of fishbone

Figure

• 

  Fig. 1. Preoperative laryngoscope image (A) and air-tracheogram (B).

• 

  Fig. 2. Representative preoperative computed tomography scan. The imaging findings revealed an abscess formation, medial to the sternocleidomastoid muscle and posterolateral to the thyroid gland (arrow). A suspicious foreign body-like material (linear-shaped, high density) was also found near the right common carotid artery (arrowhead). (A, B) Axial views. (C, D) Coronal view.

• 

  Fig. 3. Representative image of the operation field. (A) The sternocleidomastoid muscle was dissected due to severe adhesion and sclerosis throughout the strap muscle, thyroid, and adjacent tissue. (B) A fishbone (arrow) was found on the medial side of the sternocleidomastoid muscle. The fishbone was measured to be 3 cm in length.

• 

  Fig. 4. Schematic algorithm for the management of suspicious foreign bodies in the neck. a)Suspicious complications include unstable vital signs, leukocytosis, C-reactive protein elevation, or severe swelling on the neck.

Reference

References

1. Shim WY, Jeong WH, Park JB, Kim CA, Baik SK. Two cases of fish bone foreign body presenting as tongue and neck mass. Korean J Otolaryngol. 2001; 44:556–9.

2. Chee LW, Sethi DS. Diagnostic and therapeutic approach to migrating foreign bodies. Ann Otol Rhinol Laryngol. 1999; 108:177–80.

3. Ma DH, Lee YS, Lee MJ, Yim JS, Kim BC. A clinical study of foreign bodies in the food and air passages: in 649 cases for 8 years. Korean J Otolaryngol. 1989; 32:923–8.

4. Kim JP, Kwon OJ, Shim HS, Kim RB, Kim JH, Woo SH. Analysis of clinical feature and management of fish bone ingestion of upper gastrointestinal tract. Clin Exp Otorhinolaryngol. 2015; 8:261–7.

5. Chung SM, Kim HS, Park EH. Migrating pharyngeal foreign bodies: a series of four cases of saw-toothed fish bones. Eur Arch Otorhinolaryngol. 2008; 265:1125–9.

6. Hong JC, Lee HS, Kim JY, Lee KD. A case of fish bone foreign body presenting as tongue base abscess. J Clin Otolaryngol Head Neck Surg. 2006; 17:270–2.

7. Bendet E, Horowitz Z, Heyman Z, Faibel M, Kronenberg J. Migration of fishbone following penetration of the cervical esophagus presenting as a thyroid mass. Auris Nasus Larynx. 1992; 19:193–7.

8. Feldhusen F, Braunbeck T, Wallner F. Dysphagia after eating sea foods: pyriform sinus foreign body with perforation and abscess of the parapharyngeal space. HNO. 1999; 47:746–7.

9. Kim HU. Oroesophageal fish bone foreign body. Clin Endosc. 2016; 49:318–26.

10. Park JH, Park CH, Park JH, Lee SJ, Lee WS, Joo YE, et al. Review of 209 cases of foreign bodies in the upper gastrointestinal tract and clinical factors for successful endoscopic removal. Korean J Gastroenterol. 2004; 43:226–33.