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 Table of Contents  
CASE REPORT
Year : 2017  |  Volume : 2  |  Issue : 4  |  Page : 66-68

Unexpected foreign body in the neck: A case report


Department of Oral and Maxillofacial Surgery, KLE Dental College and Hospital and Research Centre, Bengaluru, Karnataka, India

Date of Web Publication9-Nov-2017

Correspondence Address:
Anubhav Jannu
Department of Oral and Maxillofacial Surgery, KLE Dental College and Hospital and Research Centre, Bengaluru, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijssr.ijssr_3_17

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  Abstract 

Foreign bodies may be deposited, ingested, or inserted in the head and neck region by a traumatic or iatrogenic injury. The penetrating foreign body in the neck has a specific apprehension because of the constellations of vital structures in the neck. We report a 30-year-old male patient who presented with a mass in the neck. Radiographic examination revealed a sharp no. 11 surgical blade in the left side of the neck. He was unaware of the foreign body in his neck and was asymptomatic. The blade was surgically removed followed by primary closure under general anesthesia. The patient recovered well without any complication. The importance of this article is the presence of a surgical blade in the neck which has never been mentioned in the literature so far and the surgical technique in which it was removed followed by the postoperative care.

Keywords: Foreign bodies, hemodynamically, orthopantomogram, suprahyoid


How to cite this article:
Jannu A, Balakrishna R, Sudarshan H, Veena G C, Srinivasan B. Unexpected foreign body in the neck: A case report. IJS Short Rep 2017;2:66-8

How to cite this URL:
Jannu A, Balakrishna R, Sudarshan H, Veena G C, Srinivasan B. Unexpected foreign body in the neck: A case report. IJS Short Rep [serial online] 2017 [cited 2018 Aug 20];2:66-8. Available from: http://www.ijsshortreports.com/text.asp?2017/2/4/66/217106


  Introduction Top


Deposited foreign bodies are not so common problem among any age group. In the head and neck region, these foreign bodies are interesting and at times challenging to locate and remove.[1],[2],[3] They may be deposited by a traumatic or iatrogenic injury. The case described here is a report of a deposited no. 11 surgical blade into the neck, which the patient was unaware of.[4] This case highlights the possibility that relatively big sharp blade can also penetrate the neck and present as a foreign body in the neck. The patient was operated in a private hospital under general anesthesia.


  Case Report Top


A healthy 30-year-old male patient was referred to us with a firm fibrous mass in the left side of the neck. He was asymptomatic but gives a history of swelling for 5 years. An orthopantomogram revealed a foreign body (no. 11 surgical blade) with prominent margins inferior to the base of the mandible and superior to the suprahyoid muscle in the left side of the neck [Figure 1], being completely embedded in the soft tissue. No evident scars were present on the skin, and no fistula was found with the deeper tissues. The patient gives a history of extraction of the lower left first molar tooth, which was done smooth and nonsurgically without the use of surgical blade. The patient also gives a history of trauma 5 years ago with laceration, which was sutured in a private hospital under local anesthesia. Hence, the patient is unaware of the surgical blade (no. 11) in the left side of his neck.
Figure 1: Orthopantomogram showing surgical blade in the left side

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Physical examination revealed a firm fibrotic mass measuring 2 cm × 2 cm in the left side of his neck. There was no tenderness or pain in and around that region. The rest of the head and neck did not reveal any scars or abnormalities. The blood samples revealed everything normal. The patient was hemodynamically stable. There was no history of smoking or alcohol consumption.

The patient was hospitalized after initial examination, followed by taking orthopantomogram and an informed consent. In the operation theater under general anesthesia, the mass was explored by a submandibular incision perpendicular to the long axis of the foreign body on the neck. After subplatysmal dissection, the surgical blade was identified [Figure 2]. All the fibrotic bands around the blade were dethatched. It had not damaged any vital structures. The surgical blade was completely exposed followed by the identification of the broken tip initially and later removal of the entire blade [Figure 3]. A good primary closure was achieved. Intravenous antibiotics, analgesics, and prophylaxis of tetanus were administered in appropriate doses. Follow-up after the 3rd, 7th and 15th day revealed complete healing of the wound.
Figure 2: Intraoperative image of the foreign body

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Figure 3: Surgical blade

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  Discussion Top


Since ages, deposited or impacted foreign bodies have been a less amusement to the clinicians as well as to the population. Sometimes, it may turn out uneventfully otherwise it endangers the life of the patient depending on the type, size, and location of the foreign body.[2],[5] Deposition or impaction of foreign bodies is a very scary situation for the patient as well as their close ones. They are usually secondary to a gunshot or stab wound.[6],[7] There have been reports of impacted chopsticks,[8] pen,[6] and wooden piece.[2] However, retention of a surgical blade (no. 11) is less reported. The diagnosis of penetrating neck trauma with an associated foreign body in situ is generally quite obvious from history or clinical examination. However, identifying a foreign body can be very challenging at times, especially in cases where the impacted body is very thin or radiologically not very clear.[6],[9] Precise localization of the foreign object is essential for complication-free removal.[6] The current mortality rate for penetrating neck injury is 3%–6%. The usual complications of penetrating neck injuries are less than 10% to as high as 20%, and a mortality rate of as high as 20% is also reported.[2],[5],[10]

The present case is interesting because of the mode of entry of the surgical blade in the neck, which the patient has been unaware of. It is also interesting in the way it travels under the subcutaneous tissue of the neck without creating any complications. It was detected with an orthopantomogram. It traveled subplatysmally and was stuck 5 mm below the base of the mandible on the left side of the neck. To prevent any complications intraoperatively or postoperatively, the wound should be explored by horizontal incision in the skin crease with proper wound debridement.

Thorough knowledge of the anatomy of the neck, physical examination and current recommendations for diagnostics and therapeutic interventions are necessary for the appropriate removal of the foreign bodies in the neck region.[11] This case report has been reported in line with the SCARE Guideline.[12]


  Conclusion Top


Foreign bodies in the neck are an uncommon but potentially life-threatening and crisis condition. Preoperative imaging is very important in deciding upon the surgical approach for the retrieval of impacted foreign bodies. A thorough knowledge of the anatomy and various management protocols with a changing technique compels the surgeon to perform a close evaluation of the patient. Each maneuver should be directed to reduce the rate of morbidity and mortality by means of timely intervention. In cases of surgical blade as foreign bodies, early exploration and surgical removal reduces the chances of fibrosis, infection, and damage to vital structures, resulting in a favorable outcome.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Hunter TB, Taljanovic MS. Foreign bodies. Radiographics 2003;23:731-57.  Back to cited text no. 1
    
2.
Singh RK, Bhandary S, Karki P. Managing a wooden foreign body in the neck. J Emerg Trauma Shock 2009;2:191-5.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Dua R, Morgan N and Kichenaradjou A. Foreign bodies. Oral and Maxillofacial Surgery 2011;40:1149.  Back to cited text no. 3
    
4.
Ozturk K, Turhal G, Gode S, Yavuzer A. Migration of a swallowed blunt foreign body to the neck. Case Rep Otolaryngol 2014;2014:646785.  Back to cited text no. 4
    
5.
Kendall JL, Anglin D, Demetriades D. Penetrating neck trauma. Emerg Med Clin North Am 1998;16:85-105.  Back to cited text no. 5
    
6.
Rao LP, Peter S, Sreekumar KP, Iyer S. A 'pen' in the neck: An unusual foreign body and an unusual path of entry. Indian J Dent Res 2014;25:111-4.  Back to cited text no. 6
[PUBMED]  [Full text]  
7.
Wakisaka H, Takahashi H, Ugumori T, Motoyoshi K. A case of wooden foreign body penetrating the oral cavity and reaching the posterior neck. Inj Extra 2010;41:92-6.  Back to cited text no. 7
    
8.
Park SH, Cho KH, Shin YS, Kim SH, Ahn YH, Cho KG, et al. Penetrating craniofacial injuries in children with wooden and metal chopsticks. Pediatr Neurosurg 2006;42:138-46.  Back to cited text no. 8
    
9.
Hersman G, Barker P, Bowley DM, Boffard KD. The management of penetrating neck injuries. Int Surg 2001;86:82-9.  Back to cited text no. 9
    
10.
Nason RW, Assuras GN, Gray PR, Lipschitz J, Burns CM. Penetrating neck injuries: Analysis of experience from a Canadian trauma centre. Can J Surg 2001;44:122-6.  Back to cited text no. 10
    
11.
Gracias VH, Reilly PM, Philpott J, Klein WP, Lee SY, Singer M, et al. Computed tomography in the evaluation of penetrating neck trauma: A preliminary study. Arch Surg 2001;136:1231-5.  Back to cited text no. 11
    
12.
Agha RA, Fowler AJ, Saeta A, Barai I, Rajmohan S, Orgill DP, et al. The SCARE statement: Consensus-based surgical case report guidelines. Int J Surg 2016;34:180-6.  Back to cited text no. 12
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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