Clinical otolaryngology and allied sciences
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Clin Otolaryngol Allied Sci · Dec 1992
Ingested foreign bodies: patient-guided localization is a useful clinical tool.
We prospectively studied the latest 60 patients who presented to the ENT Departments of St Mary's and St George's Hospitals with ingested foreign bodies. Localization of the foreign body by the patient was compared to the actual site of the foreign body at removal and graded accordingly. Localization was better the higher the object. ⋯ This suggests that for a patient who is able to lateralize a presumptive foreign body within the cervical region, then that object is likely to be above cricopharyngeus and on the side indicated. Further, it is likely to be visible on indirect laryngoscopy and amenable to removal in the casualty department. We hypothesize that the pharyngeal innervation by the vagus and glossopharyngeal nerves provides better sensation than in the oesophagus which is innervated less densely by the vagus and cervical sympathetic nerves.
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Plain radiographs are often taken to localize fishbones which lodge in the pharynx. In this study a pig's neck was used to determine the radio-opacity of 14 different species of fishbones. Radiographs were taken with bones placed in up to four of the common sites of impaction and assessed on two occasions independently by two previously uninvolved ENT consultants. ⋯ The most opaque bones were cod, haddock, grey mullet and lemon sole. The site most often detected was the laryngopharynx and that most often missed was the tonsil. This study is clinically relevant because it is useful to know which species of fishbone are radio-opaque when clinical examination fails to reveal a foreign body and may clarify the decision to proceed to endoscopy.