impaction of ingested foreign bodies in the upper aerodigestive tract is a common emergency in the otolaryngology practice [ 13 ] . foreign body impaction commonly occurs in children , mentally challenged , intoxicated adults , and in some manual professions such as electricians , fishermen , and carpenters who hold small items between their teeth while they are working . usually , patients present with respiratory distress , change in voice quality , or swallowing problems that are preceded by a vigorous or severe attack of choking and coughing [ 5 , 6 ] . this paper describes impaction of a large chicken bone in the hypopharynx in an adult male patient and its removal with guided telescopic laryngeal examination . a 28-year - old man presented with severe neck pain mainly on the left side with painful swallowing for 5 days . the patient initially had asked for medical advice at a primary health care facility and was treated with antibiotics and anti - inflammatory drugs , but there was no improvement and the pain was increasing in severity . on detailed history , the patient reported that he had an attack of choking and coughing , while he was eating chicken during dinner one day before the onset of symptoms .   on examination , there was a low - grade fever and tenderness in the left side of the neck , and the pain was exaggerated by swallowing attempts . a white linear chicken bone was seen impacted at the left pyriform fossa with a relatively free broad base pointing anteriorly , and the other tapering end was impacted in the posterior wall of the pyriform fossa ( figure 1 ) . to rule out development of a retropharyngeal abscess , anteroposterior and lateral x - ray views of the neck apart from the chicken bone that was poorly visualized in the lateral x - ray view of the neck , there was no evidence of retropharyngeal abscess formation . the bone was removed in an office - based setting under guidance of video laryngeal rigid telescopic examination . in this procedure , a video laryngeal examination was carried out using a 70-degree rigid telescope , 3ccd camera , lcd monitor , and a light source . the patient was seated in the upright position with his head supported from the back . using a cotton swab soaked with xylocaine 10% and held by a magill 's forceps , the patient 's oro- and hypopharynx were adequately anesthetized . the patient was instructed to protrude his tongue and hold it by his hand with a piece of gauze . the telescope was held by the physician 's left hand and introduced carefully into the oropharynx . when the foreign body was identified in the left pyriform fossa and clearly visualized on the monitor , it was carefully removed by a curved laryngeal forceps held by the right hand of the physician ( figure 2 ) . after that , the patient was prescribed oral antibiotics in the form of amoxycillin - clavulanic acid ( 1  gm b.i.d . for 10 days ) to control possible infection and an analgesic and anti - inflammatory drug in the form of diclofenac sodium ( 50  mg b.i.d . for 10 days ) . then , he was discharged with a scheduled followup appointment after 7 days . on the followup visit , the patient was completely improved with disappearance of the constitutional symptoms , no pain or tenderness on the neck and normal swallowing function . foreign body impaction in the larynx is mainly accidental in nature and usually presents as a respiratory emergency that requires urgent intervention to save the patient 's life . the clinical presentation may vary according to the site and size of the foreign body . with a large object impacted in the laryngeal vestibule , an acute presentation of severe coughing , choking , hoarseness , and gagging occasionally , the patient may not be able to speak , gesticulates wildly , and presents with stridor and cyanosis . however in the current case , the examination revealed the impaction of the chicken bone in the left pyriform fossa . accordingly , the presenting complaint of the patient was pain in the neck more related to swallowing . meanwhile , there were no symptoms of respiratory distress or vocal quality impairment .   usually , most impacted foreign bodies in the larynx and hypopharynx are removed by direct endoscopy under general anesthesia . this is usually performed either through a working channel in the endoscope or with the help of simultaneous transoral forceps . this technique makes some patients uncomfortable , and one must gain experience in operating the flexible nasopharyngoscope and the transoral foreign body forceps simultaneously . in addition , when using a flexible endoscope with a working channel , technical difficulty remains problematic and precise control is hard to achieve because of a poor surgical view and difficulty in manipulating the forceps [ 3 , 9 ] .   in this paper , adequate local anesthesia to the oropharynx and the hypopharynx was achieved that made introducing the rigid telescope and the instrument ( laryngeal forceps ) through the oropharynx less likely to induce a gag reflex . with the advantage of better magnification of the laryngeal and hypopharyngeal view that the rigid laryngeal telescope provides , the bone was carefully removed in an office - based setting using a curved laryngeal forceps . this paper shows that with local anesthesia to the oro- and hypopharynx , a foreign body in the hypolarynx can be comfortably removed in an ambulatory setting under the guidance of video laryngeal telescopic examination .
objective . to describe a rare case of an impacted large foreign body ( chicken bone ) in the laryngopharynx . 
 case report . 
 a 28-years - old man presented with pain in the neck of 5 days duration . 
 the patient gave a history of severe choking sensation while eating chicken . 
 laryngoscopic examination revealed a linear whitish large chicken bone impacted in the left pyriform fossa . 
 the bone was removed under local anesthesia with the guidance of telescopic laryngeal examination . 
 conclusion . 
 this paper describes impaction of a large chicken bone in the hypopharynx in an adult male patient and its removal with guided telescopic laryngeal examination .