Lateral Soft Tissue X-ray for Patients with Suspected Fishbone in Oropharynx, A thing in the past

Document Type: Original

Authors

1 Department of Otolaryngology, Addenbrookes Hospital, Cambridge, UK.

2 Magee-Women’s Hospital of UPMC, University of Pittsburgh, USA.

3 Burke Mountain Medical Centre, BC, Canada.

Abstract

Introduction:
Fishbone is the most common foreign body found in the oropharynx. Conventionally patients with suspected fishbone in the throat would have mirror laryngoscopy followed by lateral soft tissue X-ray to look for the fishbone or observe impacts caused by the fishbone i.e. soft tissue swelling or air in upper esophagus. However, the most common site of fishbone impact is the suprahyoid area, which contains high soft tissue and bony density. This makes X-rays less reliable, especially because not all fish have radio-opaque bones. With the advent of fibreoptic nasendoscopy (FNE) and improved access to CT scan, more reliable tools exist to treat patients with suspected fishbone in the oropharynx;
 
Materials and Methods
A retrospective study, looking at 698 lateral soft tissue X-rays was performed. This study was conducted in Addenbrookes Hospital, Cambridge (UK) between December 1st, 2004 and February 28th, 2011 using picture archiving and communication systems (PACS). All the radiology reports were reviewed and all the lateral soft tissue X-ray requests for foreign bodies other than fish bones were excluded.  
 
Results:
Of the 698 lateral soft tissue X-rays performed between December 1st, 2004 and February 28th, 2011, only 229 (32.8%) were suspected to involve a fishbone in the throat. Amongst those requested for suspected fishbone injury, only 23 (10%) cases were reported by the radiologist as positive for fishbone. Of the 23 patients with a positive finding on X-ray, 13 had negative FNE and were discharged from the hospital, while 5 had fishbone which were visualized using fibreoptic nasendoscope and removed. One patient had an appointment in order to be reviewed in the clinic, but did not show up. The notes for 4 patients were not found; however, there were no records on the hospital intranet suggesting that they had been to the operating room for an ENT procedure related to fishbone. Therefore, it is fair to assume that either there was no fishbone to be found or it was picked up during fibreoptic nasendoscopy and removed under local anesthesia.
 Conclusion: 
Requesting lateral soft tissue X-ray is not beneficial in cases with a suspected fishbone in the oropharynx when fibreoptic nasendoscope is readily available.

Keywords

Main Subjects


1. Knight LC, Lesser TH. Fish bones in the throat. Arch Emerg Med 1989; 6(1):13-6.

2. Evans RM, Ahuja A, Rhys Williams S, Van Hasselt CA. The lateral neck radiograph in suspected impacted fish bones-does it have a role? Clin Radiol 1992; 46(2):121-3.

3. Akazawa Y, Watanabe S, Nobukiyo S,  Iwatake H, Seki Y, Umehara T, et al. The management of possible fishbone ingestion. Auris Nasus Larynx 2004;31(4):413-6.

4. O'Flynn P, Simo R. Fish bones and other foreign bodies. Clin Otolaryngol Allied Sci 1993; 18(3):231-3.

5. Nathan B, Premachandran S, Hashemi K. Removal of fish bones from the throat. J Accid Emerg Med 1995;12(4):303.

6. Hone SW, Fenton J, Clarke E, Hamilton S, McShane D. The radio-opacity of fishbones: a cadaveric study. Clin Otolaryngol Allied Sci 1995; 20(3):234-5.

7. Giger R, Landis BN, Dulguerov P. Uncommon position of a retropharyngeal impacted fishbone. Laryngorhinootologie 2004;83(12):852-5.

8. Vásquez JC, Montesinos E, Castillo L, Rojas L, Peralta J. Esophageal perforation and mediastinitis caused by fishbone ingestion: report of 3 cases. Rev Gastroenterol Peru 2006; 26(4):400-3.