A Reclusive Foreign Body in the Airway: A Case Report and a Literature Review

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 1–3 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—radiopaque 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.