Removal of fishbone under local anaesthetic using flexible nasal endoscopy: a novel technique

Background

Fish bone ingestion is one of the most common emergency ENT presentations.¹ These require urgent removal to prevent complications. After the tonsils, the second most common site of impaction is at the base of tongue.² These can be difficult to access and often require removal under a general anaesthetic.³ We describe a novel technique of removing a fishbone from the base of tongue using a flexible nasal endoscope in conjunction with disposable lung biopsy forceps under local anaesthetic.

Technique

Biopsy forceps with an alligator jaw are attached along the flexible shaft of a nasal endoscope at multiple points using an adhesive tape (Figure 1). Topical 10% Lidocaine is sprayed to the back of the patient’s throat for local anaesthesia and flexible endoscopy is performed via the nasal or oral route. Once the fishbone has been localised it can be grasped within the jaws of the biopsy forceps and removed (Figure 2 and Supplementary Video 1).

Figure 1 .

Biopsy forceps attached to the tip of the flexible nasal endoscope

Figure 2 .

Biopsy forceps and flexible nasal endoscopy setup with biopsy grasping operator

Discussion

This simple fish bone removal technique under local anaesthetic is exceptionally favourable and versatile in its application, particularly in centres where biopsy port flexible nasoendoscopic examination is not available. It uses easily accessible equipment in the outpatient setting, avoids the risks of general anaesthetic, saves valuable CEPOD theatre time alongside the benefit of increased patient safety, comfort and early discharge.