PMC9363669_01
(A, B) Axial and sagittal CT images of patient on initial presentation; (C) laryngoscopy view of the posterior wall of the pharyngeal cavity before incision during the first surgery; (D) laryngoscopy view after incision of the pharyngeal mucosa during the first surgery. CT = computed tomography.
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F1
Computed tomography (CT) revealed a 1.3 cm vertical shadow in the retropharyngeal space at the level of the C4 spine, with a distance of 0.8 cm toward the pharyngeal mucosa (Figures 1A, B).
(A, B) Sagittal CT image and three-dimensional construction image of the patient after direct laryngoscopy ((A): the red arrow points to the foreign body); (C) representative images of intraoperative navigation registration: head and face contour scanning, combined with a facial marker, was used for registration, with an average registration accuracy not greater than 1.0 mm. After the model registration is completed, the patient's body position is further adjusted according to the positioning of the superior thyroid notch and the manubrium sterni (green) in the navigation model, so that the neck position from the navigation model matches the actual position of the patient's neck.
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F2
As shown in Figure 2, the chicken bone was retained but displaced downward to the C4-C5 spine.
Representative images of transcervical surgery with the combined use of both endoscope and image guidance navigation. (A) Exposure of the thyroid cartilage, thyrohyoid membrane, superior horn of the thyroid cartilage, and superior laryngeal nerves; (B) incision of a thyrohyoid membrane involved making an opening to the pharyngeal cavity; (C) successful location and retrieval of a foreign body from retropharyngeal space; (D) intraoperative positioning of the foreign body using image guidance navigation; (E) image of the foreign body.
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F3
The corresponding internal laryngeal nerve and the superior laryngeal artery were well recognized and protected in time (Figures 3A, B). Medtronic intraoperative image guidance navigation was used to locate the pharyngeal mucosa incision position for foreign body visualization (Figure 3D). A 1.3 cm chicken bone was successfully found beneath the incised pharyngeal mucosa and removed en bloc without any injury to the internal laryngeal nerves and thyroid cartilage (Figures 3C, E).