A 40-year-old male with a 20-year history of schizophrenia presented to the emergency department with long history of pharyngeal foreign body sensation which had progressed over one month to include sore throat, odynophagia, and dyspnea. Physical exam revealed asymmetric prominence of the right posterior oropharyngeal wall and trismus with maximal interincisural distance of two centimeters. There were tenderness, edema, and erythema of the right submandibular triangle without palpable mass.\nFlexible laryngoscopy showed fullness of the right posterior pharyngeal wall without mucosal abnormality, resulting in anterior displacement of the right aryepiglottic fold. This was encroaching on the airway but not causing critical airway stenosis. A computed tomography (CT) scan of the neck with contrast was obtained. This demonstrated a linear opacity extending from the oropharynx to the right thyroid ala. Reconstructed 3D images showed a uniform mass consistent with a foreign body (). Further psychiatric history was obtained and revealed a history of auditory hallucinations that had on several occasions led to suicide attempts, including one attempt two years ago in which the patient stabbed himself in the pharynx with a broken toothbrush handle. Prompt removal was recommended given risk for infection and airway compromise.\nThe patient was transorally intubated over a flexible bronchoscope and then underwent direct laryngoscopy. Swelling of the right posterior oropharynx and hypopharynx was noted (). An anterolateral neck incision was made and subplatysmal flaps were raised. The mass was easily palpated overlying the right thyroid ala, and blunt dissection allowed entry into the fibrous capsule surrounding the foreign body (). The capsule was opened, and the foreign body was removed. The length corresponded exactly to the length of the foreign body on the CT (). A sample was obtained for bacterial culture, the wound was irrigated, and a drain was placed. The patient was extubated and given a soft diet.\nVisual inspection and pathologic analysis confirmed that the foreign body was indeed a toothbrush handle. Cultures from the area grew heavy mixed bacteria including anaerobes. After an uneventful postoperative stay, the patient was discharged without complications. Discharge planning included psychiatry follow-up.
We report the case of a 4-year old girl who was admitted to our ENT outpatient clinic with a cervical neck mass without other signs and symptoms. The patients history revealed, that she had previously been treated several times for odynophagia with cervical tumescence within the last two month. Symptoms and swelling disappeared temporally after the antibiotic treatments. However, the cervical mass rapidly reappeared after the end of the treatment. Otolaryngological examination showed no particularity, beside a firm lateral cervical mass. A cervical CT scan (Fig ) revealed a deep subcutaneous collection, suggesting the presence of an cervical abscess. Potential infectious origins such as the tonsils, the salivary glands, teeth or the facial skin were calm. Despite an intravenous antibiotic treatment with decrease of the cervical mass, an ultrasound control 10 days later showed a persistent subcutaneous liquid collection. We then opted for incision and drainage of this collection. The drainage and cleaning of the abscess cavity unearthed a blade of grass within the purulent discharge (Fig ).\nReviewing the patients history, the parents suddenly recalled she had complained of a transitory foreign body feeling during several days after chewing a blade of grass two months ago. Follow-up showed no further recurrence of the neck swelling.