Images in Otorhinolaryngology
Harpoon-marking of deep tongue foreign body for surgical removal
Extracción quirúrgica de cuerpo extraño asistida por marcaje con arpón
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A) Se visualiza el paraganglioma ocupando el mesotimpano. B) Se comienza la resección con láser fotoangiolítico azul. C) Lesión parcialmente resecada. D) Cauterización de pedículos venosos que adhieren el paraganglioma al promontorio. E) Extracción de la lesión completamente resecada. F) Promontorio coclear sin lesión visible. 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When asked, the patient recalled a minor episode of fishbone ingestion with self-limited right side gingival lesion prior to the beginning of the symptoms.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A CT scan was performed for assessment of a possible cervical complication, revealing a spontaneous linear hyperdensity in the right genioglossus muscle, corresponding to the fishbone, with densification of the surrounding soft tissues, reflecting areas of edema/phlegmon (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Three abscesses with peripheral contrast enhancement were also present in relation to the path of the fishbone (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The patient underwent 2 surgical attempts at removing the foreign body, by both oral and cervical approaches, but without success.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The case was then rediscussed together with Neuroradiology and a metal harpoon was placed adjacent to the foreign body for surgical reference, guided by CT (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). A new cervical approach proved then successful by following the external portion of said harpoon internally, until the finding and removal of the fishbone was achieved.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Afterwards, the patient underwent additional antibiotic treatment and extensive speech therapy, having made a full recovery and regained full use of the tongue.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Clinicians should be on the lookout for any history of foreign body ingestion and any possible associated complications. 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