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Ann Otol Rhinol Laryngol. 2015 Feb;124(2):162-7. doi: 10.1177/0003489414547106. Epub 2014 Aug 19.

Unique migration of a dental needle into the parapharyngeal space: successful removal by an intraoral approach and simulation for tracking visibility in X-ray fluoroscopy.

Author information

  • 1Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
  • 2Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan ZAY00015@nifty.com.
  • 3Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan.

Abstract

OBJECTIVES:

The first objective was to describe a novel case of migration of a broken dental needle into the parapharyngeal space. The second was to address the importance of simulation elucidating visualization of such a thin needle under X-ray fluoroscopy.

METHODS:

Clinical case records (including computed tomography [CT] and surgical approaches) were reviewed, and a simulation experiment using a head phantom was conducted using the same settings applied intraoperatively.

RESULTS:

A 36-year-old man was referred after failure to locate a broken 31-G dental needle. Computed tomography revealed migration of the needle into the parapharyngeal space. Intraoperative X-ray fluoroscopy failed to identify the needle, so a steel wire was applied as a reference during X-ray to locate the foreign body. The needle was successfully removed using an intraoral approach with tonsillectomy under surgical microscopy. The simulation showed that the dental needle was able to be identified only after applying an appropriate compensating filter, contrasting with the steel wire.

CONCLUSION:

Meticulous preoperative simulation regarding visual identification of dental needle foreign bodies is mandatory. Intraoperative radiography and an intraoral approach with tonsillectomy under surgical microscopy offer benefits for accessing the parapharyngeal space, specifically for cases medial to the great vessels.

© The Author(s) 2014.

KEYWORDS:

X-ray fluoroscopy; compensating filter; needle migration; parapharyngeal space; surgical microscope

PMID:
25139135
[PubMed - indexed for MEDLINE]
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