Abstract

Introduction: Oesophageal foreign bodies are a potential emergency, due to the risk of oesophagealperforation leading to mediastinitis which has a significant mortality rate. After negative direct examination, first line investigation is a lateral soft tissue neck x-ray, however interpretation of these by doctors in training can be difficult and there can be misleading non-pathological calcification of the laryngeal framework.

Case Series: We present 3 cases of upper oesophageal obstruction secondary to dental plate ingestion. In all three cases a foreign body was not initially noted on lateral soft tissue x-ray but due to the high index of clinical suspicion, all three underwent intervention. Two required rigid oesophagoscopy and removal in theatre and the third tolerated removal under local anaesthetic using McGills forceps.

Discussion: The case series highlights the potential difficulty in identifying oesophageal foreign bodies lodged at the level of the cricopharyngeus. Inclusion of a radio-opaque marker on dental plates would allow for easy identification of dental foreign bodies and avoid unnecessary procedures on a vulnerable and often frail patient group. If there are no visible radiological signs, patients should still undergo rigid oesophagoscopy if there is a high index of clinical suspicion.

Abstract

Objective: To report a case of vocal cord actinomycosis and provide a systematic review of the literature to provide a reference for its diagnosis and management.

Review Methods: Relevant cases from a PubMed search were reviewed for age/gender, risk factors, clinical manifestations, and treatment.

Results: Thirty-two cases of laryngeal actinomycosis have been reported in the literature. Most (80%) cases presented in patient with known risk factors. The majority presented with dysphonia (61.5%). Thirteen (58.3%) involved the true vocal cords. Penicillin based therapy was treatment of choice.

Conclusion: A structured assessment revealed 32 cases of laryngeal actinomycosis in the literature. Actinomycosis should be considered on the differential, even in healthy individuals with symptoms of laryngeal impairment.