Occult Aspiration of Chicken Wishbone Lodged in the Larynx
A 22 years old non smoker male with Down’s syndrome, hypothyroidism, ventricular septal defect repaired at three months of age presented with a hoarse voice and biphasic stridor on exertion. He complained that he recently over the last three months became unable to fully engage in playing and coaching football. His voice has become gruffly, short of breath with noisy breathing on exercising. He had two course of antibiotic by his GP as diagnosed with laryngitis. Examination with fibreoptic nasendoscopy showed granulation tissue and swelling of the vocal cords. A CT neck was requested which showed the narrow airway and the wishbone foreign body.Figure1&2 Tracheostomy under local anaesthetic was performed in a standard technique prior to Microlaryngobronchoscopy to secure the airway. On direct pharyngo-laryngoscopy a chicken wishbone was seen surrounded by vocal cords’ granulation tissue. Figure3 Using rigid grasping forceps endoscope, the wishbone was dislodged distally before retrieved in toto.Figure4 The patient made an unremarkable recovery. He was kept under observation in the intensive care unit for two days then to the general ENT ward. He had systemic steroids (Dexamethasone) for three days and Augmentin antibiotic for a week. He was discharged eight days later. He was weaned of his tracheostomy tube before discharge. The patient was reviewed a month later; he had full restoration of his original quality of voice.
Laryngeal foreign body typically presents as an emergency requiring surgical intervention. Airway foreign bodies are more common in children than adults, boys more than girls [ ]. Other cases have been reported of foreign bodies in the larynx but few are of chronic nature. These cases commonly include children or patients with learning difficulties and/or cognitive impairment .
There are few cases in the literature involving chicken wishbones in adults, none that are lodged in the larynx [ ]. Asymptomatic coin lodged in the larynx has been reported [ ]. Ingested impacted wishbone in the gut was previously reported [ ]. In our case the significance was that the patient did not complain to his family doctor or attended to emergency department as an emergency when it took place. Inhaled foreign body can be a challenge for diagnosis [ ]. Different techniques were described to remove the airway foreign bodies, most notably flexible and rigid bronchoscopy [ ]. In our case, due to the airway narrowing, tracheostomy was first performed under local anaesthetic to secure the airway, followed by general anaesthetic through tracheostomy tube and microlaryngobroncoscopy was performed to retrieve the wishbone.
– Occult foreign body inhalation should be considered in adults when presented with biphasic stridor, shortness of breath and cough.
– Laryngeal airway oedema and narrowing are serious consequences of foreign body inhalation
– Fibre-optic nasal endoscopy and imaging are the cornerstone to assess airway adequacy
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