Diagnostic and therapeutic aspects of intratonsillar localization of a foreign body – fish bone, possible complications: Case report

Abstract

Abstract. Introduction: The impaction of fish bones in the soft tissues of the oral cavity and pharynx is a common reason for emergency consultations in otorhinolaryngology. Due to their characteristics, as well as the anatomy of the oropharynx, such bones may remain hidden even during thorough clinical examination and can lead to serious complications such as abscess, phlegmon, mediastinitis, and in rare cases – a fatal outcome. Computed tomography is used for timely diagnosis and localization of the site of impaction.

Case report: We present a clinical case of a 50-year-old female patient with a one-week history of throat pain and a sensation of a foreign body after swallowing a fish bone. Multiple examinations, including endoscopic evaluation, failed to identify any foreign object. CT imaging revealed a fish bone completely embedded in the right palatine tonsil, as well as a formed intratonsillar abscess. Under general anesthesia, abscess-monotonsillectomy with removal of the bone was performed. The postoperative course was uneventful.

Discussion: This case highlights the diagnostic challenges associated with deeply embedded fish bones, which may remain unnoticed during standard examination. CT is a highly informative method, particularly when complications are suspected. The primary method of treatment is the immediate extraction of the bone.

Conclusion: Fish bones impacted in the soft tissues of the oral cavity and pharynx require careful evaluation and early diagnosis. In cases with no visible findings but persistent symptoms, imaging studies are mandatory. Rapid detection and timely surgical management minimize the risk of complications and improve patient outcomes.