DYSPHAGIA AS AN UNUSUAL PRESENTATION OF LARYNGEAL FOREING BODY. ENDOSCOPIC DIAGNOSIS.

Case report

A fifty years old male patient who comes to the Emergency Room due to a high dysphagia and odynophagia, without cough or dyspnea, caused by the accidental ingestion of his teeth prosthesis. A neck X-ray was done without any abnormal results and an indirect Laryngoscopy that was also reported as normal. But due to the persistence of pharyngeal pain, a gastroscopy was done in which we introduce the endoscope under direct vision without seeing any change in the pharyngeal esophageal area and no evidence of a foreign body in the esophagus, stomach or duodenum. Nevertheless, during the endoscope extraction we were able to see that the dental prosthesis was embedded in the left vallecula, as well as and evident edema in both aritenoides cartilages (Figs. 1-4). For that reason the extraction was done in the operating theatre by the otolaryngologist on duty, under general anesthesia and previous orotracheal intubation.

Figure 1 y 2

Teeth prosthesis embedded in left vallecula.

Figure 3 y 4

Size of the teeth prosthesis.

Discusión

The ingestion of pharyngeal esophageal foreign bodies is a frequent problem in the Emergency Room, almost all due to fish bones and small animal bones. The nature of the foreign body will determine the subsequent clinical picture, not being rare the phenomenon of the upper airway obstruction, the migration to the deep neck area, peritousilar abscess and/or perforation of the upper aero digestive level, causing serious complications such as hemorrhages, perforation, aspiration, pneumo mediastino and mediastinitis. The esophageal peristaltic movements can contribute to its deep embedding through the esophageal wall.

The diagnosis can be difficult in cases when the patients are not aware of the ingestion such as small children, mentally disabled patients or the elderly using teeth prosthesis, in which the CAT-Scan is the chosen test. There is normally associated a remarkable morbidity and in some cases, mortality, so that an urgent and qualified extraction is required.

We are presenting this case, because of its rare presentation as it deals with laryngeal foreign body (Figs 1-4) that appears as a high dysphagia, without dyspnea, stridor cough or dysphonia. And because, the diagnosis was carried out by a digestive specialist during the endoscope extraction. We are high-lighting the importance of direct vision during the introduction, in this way, the pharyngeal esophageal area can be explored without difficulty. It is as important the careful exploration of all the areas during the endoscope extraction. As in this case, this method allowed us to see a laryngeal foreign body, was not seen during the endoscopy introduction, probably because it was embedded in the deep neck area and when the endoscope was removed, the foreign body was pulled out to the outer area allowing it to be seen in the left vallecula before the endoscopy had been finished.