%0 Journal Article
%T A Reclusive Foreign Body in the Airway: A Case Report and a Literature Review
%A Ajay Philip
%A V. Rajan Sundaresan
%A Philip George
%A Satyabrata Dash
%A Regi Thomas
%A Anand Job
%A V. K. Anand
%J Case Reports in Otolaryngology
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/347325
%X A foreign body in the larynx is an airway emergency that requires urgent evaluation and treatment. Irregular foreign bodies tend to orient in a sagittal plane and may produce only partial obstruction, allowing adequate air movement, hence making them undetectable for a long period of time. We report a case of a laryngotracheal foreign body that remained reclusive for 9 years. 1. Introduction Foreign bodies in the airway are a dire emergency and are a challenge to the otolaryngologist. They require prompt medical attention and rapid airway access. They occur less frequently in adults [1, 2]. Children are the common victims, with the highest incidence being in patients below 15 years [3] of which majority fall in 1¨C3 age group and of which 25% are below 1 year. The male to female ratio of tracheobronchial foreign bodies varies from 2£¿:£¿1 [4, 5] to 3£¿:£¿2 [6]. The true incidence may be illusive, and the sole reason is that most symptoms are nonspecific. A history of aspiration may be obtained in patients who present with acute symptoms, but individuals with chronic foreign bodies vaguely remember one [7, 8]. 2. Case Report A 39-year-old Indian male presented to our outpatient department with a 9-year history of intermittent odynophagia and hoarseness, associated with noisy breathing. He recalled that his aforementioned symptoms began in a certain day after work; however, he did not seek medical attention. He presented to us 9 years later with mild biphasic stridor and indirect laryngoscopy revealed a subglottic proliferative growth compromising the tracheal luminal airway. X-ray neck lateral view revealed a subglottic narrowing at C6-C7 level (Figure 1) (black arrow). Figure 1: X-ray neck lateral view¡ªradiopaque foreign body at C6-C7 level. Computed tomography of the neck showed a circumferential wall thickening involving the subglottic region and adjoining trachea causing mild luminal narrowing for a segment measuring approximately 27£¿mm (Figure 2) (orange arrow). Figure 2: Circumferential thickening in the subglottic region. A working diagnosis of subglottic growth/idiopathic subglottic stenosis was made. The patient was tracheostomized prior to examination under anesthesia in view of a compromised airway. A zero degree telescopic assessment of the larynx was done and a single tablet foil was noted at the level of the first and the second tracheal ring surrounded by thick granulation tissue (Figure 3). Figure 3: Tablet foil with surrounding granulation tissue. The foil was removed and the adjacent granulation tissue was excised by cold steel excision.
%U http://www.hindawi.com/journals/criot/2013/347325/