Clinical Photograph
An Unexpected Foreign Body: A Hypopharyngeal Ant Hao-Mu Chang, MD1, and Geng-He Chang, MD2
Otolaryngology– Head and Neck Surgery 2015, Vol. 153(4) 683–684 Ó American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/0194599815577088 http://otojournal.org
No sponsorships or competing interests have been disclosed for this article.
Keywords foreign body, hypopharynx, ant Received December 22, 2014; revised February 11, 2015; accepted February 20, 2015.
Case Presentation A 7-year-old male was brought to our emergency department with a sensation of a persistent lump in his throat after drinking an unsealed carbonated beverage. Flexible nasopharyngoscopy revealed a black ant in the right hypopharynx. Despite repeatedly drinking water, the ant could not be swallowed, and it had firmly attached to the posterior pharyngeal wall (Figure 1). After discussion with his family, it was decided to proceed with suspension laryngomicrosurgery under general anesthesia. Before the removal, we protected the airway with saline-rinsed cotton balls and then used a 10% Lidocaine-rinsed cotton ball to soak the ant, which was already dead during the removal. An additional foreign body was excluded by rigid esophagoscopy. The ant measured 6 mm in body length and had 2 antennae and faint bands on its abdomen (Figure 2). It may have been
Figure 2. By suspension laryngomicrosurgery, complete removal of the black ant was achieved smoothly. The ant measured 6 mm in body length and had 2 antennae and faint bands on its abdomen.
Polyrhachis dives, which is a common house-infesting ant throughout tropical Asia, including Taiwan. Its mouth parts have well-developed mandibles with keen teeth, which provide powerful bites in hunting and defense.
Discussion Mis-swallowing a living ant gripping on the hypopharynx is an extremely rare condition, which may occur after eating or drinking substances contaminated with ants. The ant may bite the mucosa of the aerodigestive tract with its jaws, leading to odynophagia and a feeling of a lump in the throat. In this patient, the ant was removed completely using suspension laryngomicrosurgery, which provided a clear surgical view1,2 and allowed for delicate manipulation without disrupting the ant. This case highlighted the possibility of mis-swallowing a living ant. Clinicians should keep a high index of suspicion 1 Department of Otolaryngology–Head and Neck Surgery, Chang Gung Memorial Hospital, Linco, Taiwan 2 Department of Otolaryngology–Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
Figure 1. Flexible nasopharyngoscopy disclosed a black ant tightly attaching on the posterior wall of the right hypopharynx. The inset shows the delicate structure of the ant.
Corresponding Author: Geng-He Chang, MD, Department of Otolaryngology–Head and Neck Surgery, Chang Gung Memorial Hospital, No. 6, W. Sec., Jiapu Rd., Puzi City, Chiayi County 613, Taiwan (R.O.C.). Email: [email protected]
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Otolaryngology–Head and Neck Surgery 153(4)
and pay attention to symptoms arising immediately after eating unsealed food or beverage that may be contaminated with insects. Approval of the case study was obtained from the Institutional Review Board of Chang Gung Memorial Hospital. Author Contributions Hao-Mu Chang, organized, drafted, and accomplished the article; Geng-He Chang, provided the case materials, revised the manuscript, and made final approval of the version to be published.
Sponsorships: None. Funding source: None.
References 1. Swanson PB, Apicella SA, Rosen CA. Removal of a triplebarbed fishhook from the hypopharynx with microlaryngoscopy. Am J Otolaryngol. 2002;23:233-236. 2. Shu MT, Leu YS. Microscopic removal of an embedded foreign body from the hypopharynx: report of two cases. Ear Nose Throat J. 2001;80:889-890.
Disclosures Competing interests: None.
Downloaded from oto.sagepub.com at UNIV MASSACHUSETTS AMHERST on June 5, 2016
An Unexpected Foreign Body: A Hypopharyngeal Ant Hao-Mu Chang, MD1, and Geng-He Chang, MD2
Otolaryngology– Head and Neck Surgery 2015, Vol. 153(4) 683–684 Ó American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/0194599815577088 http://otojournal.org
No sponsorships or competing interests have been disclosed for this article.
Keywords foreign body, hypopharynx, ant Received December 22, 2014; revised February 11, 2015; accepted February 20, 2015.
Case Presentation A 7-year-old male was brought to our emergency department with a sensation of a persistent lump in his throat after drinking an unsealed carbonated beverage. Flexible nasopharyngoscopy revealed a black ant in the right hypopharynx. Despite repeatedly drinking water, the ant could not be swallowed, and it had firmly attached to the posterior pharyngeal wall (Figure 1). After discussion with his family, it was decided to proceed with suspension laryngomicrosurgery under general anesthesia. Before the removal, we protected the airway with saline-rinsed cotton balls and then used a 10% Lidocaine-rinsed cotton ball to soak the ant, which was already dead during the removal. An additional foreign body was excluded by rigid esophagoscopy. The ant measured 6 mm in body length and had 2 antennae and faint bands on its abdomen (Figure 2). It may have been
Figure 2. By suspension laryngomicrosurgery, complete removal of the black ant was achieved smoothly. The ant measured 6 mm in body length and had 2 antennae and faint bands on its abdomen.
Polyrhachis dives, which is a common house-infesting ant throughout tropical Asia, including Taiwan. Its mouth parts have well-developed mandibles with keen teeth, which provide powerful bites in hunting and defense.
Discussion Mis-swallowing a living ant gripping on the hypopharynx is an extremely rare condition, which may occur after eating or drinking substances contaminated with ants. The ant may bite the mucosa of the aerodigestive tract with its jaws, leading to odynophagia and a feeling of a lump in the throat. In this patient, the ant was removed completely using suspension laryngomicrosurgery, which provided a clear surgical view1,2 and allowed for delicate manipulation without disrupting the ant. This case highlighted the possibility of mis-swallowing a living ant. Clinicians should keep a high index of suspicion 1 Department of Otolaryngology–Head and Neck Surgery, Chang Gung Memorial Hospital, Linco, Taiwan 2 Department of Otolaryngology–Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
Figure 1. Flexible nasopharyngoscopy disclosed a black ant tightly attaching on the posterior wall of the right hypopharynx. The inset shows the delicate structure of the ant.
Corresponding Author: Geng-He Chang, MD, Department of Otolaryngology–Head and Neck Surgery, Chang Gung Memorial Hospital, No. 6, W. Sec., Jiapu Rd., Puzi City, Chiayi County 613, Taiwan (R.O.C.). Email: [email protected]
Downloaded from oto.sagepub.com at UNIV MASSACHUSETTS AMHERST on June 5, 2016
684
Otolaryngology–Head and Neck Surgery 153(4)
and pay attention to symptoms arising immediately after eating unsealed food or beverage that may be contaminated with insects. Approval of the case study was obtained from the Institutional Review Board of Chang Gung Memorial Hospital. Author Contributions Hao-Mu Chang, organized, drafted, and accomplished the article; Geng-He Chang, provided the case materials, revised the manuscript, and made final approval of the version to be published.
Sponsorships: None. Funding source: None.
References 1. Swanson PB, Apicella SA, Rosen CA. Removal of a triplebarbed fishhook from the hypopharynx with microlaryngoscopy. Am J Otolaryngol. 2002;23:233-236. 2. Shu MT, Leu YS. Microscopic removal of an embedded foreign body from the hypopharynx: report of two cases. Ear Nose Throat J. 2001;80:889-890.
Disclosures Competing interests: None.
Downloaded from oto.sagepub.com at UNIV MASSACHUSETTS AMHERST on June 5, 2016
