Retrieval of Migrated Embedded Sewing Machine Needle from the Tongue

Abstract

Foreign body in the oral cavity can be encountered by Head and Neck Surgeons in their clinical practice. Here, we report a rare case of an embedded sewing machine needle in the posterior tongue that migrated by tongue movements, and was retrieved successfully by surgical intervention.

Introduction

Foreign body in the oral cavity can be encountered by Head and Neck Surgeons in their clinical practice. The commonly retrieved foreign bodies are tooth fragments [1] and fish bones [2] The anterior and mobile part of the tongue may be one of the sites involved whilst accidental entrapment of needle in the deep, posterior part of the tongue is rare [3], and may lead to various complications like pain, swelling, infection, and difficulty in swallowing. If not managed, it may cause progression of infection to abscess and airway obstruction which is life-threatening. Undiagnosed foreign body entrapment in the tongue may mimic malignancy as they show clinical features of an enlarging lesion [4, 5]

The tongue is a large muscular organ in the oral cavity that frequently moves during various activities. Hence, foreign body entrapment in this region undergoes migration which is an uncommon but alarming complication that requires prompt management. Untoward complications like recurrent neck infection, encroachment of the facial artery, and abscess of retropharyngeal space have been reported [6] Hence, the Head and Neck Surgeons should be aware of the consequences of such foreign body entrapment and migration. Here, we report a case of an embedded sewing machine needle in the posterior tongue that migrated with tongue movements and was retrieved successfully by surgical intervention.

Case Report

A 22-year-old male presented to our Emergency Department with a history of accidental penetration of a sewing machine needle in his tongue while threading the needle. The patient complained of severe pain and difficulty in swallowing. On intraoral examination, no entry point of the needle was noticed as the patient claimed, and there was no active bleeding from the site. Palpation of the posterior region of the dorsum of the tongue indicated the presence of the foreign body. Radiographic evaluation was done to determine the exact location of the foreign body and to rule out any airway obstruction. The lateral view of the neck revealed a radio-opaque foreign body parallel to the lower border of the mandible in the posterior oral cavity (Fig. 1).

Fig. 1.

Lateral neck X ray showing position of the needle (white arrow)

Within few minutes after the radiograph was taken, the patient complained of a sensation of foreign body movement within the tongue. Due to anxiety and difficulty in swallowing, the patient repeatedly made tongue movements, against the advice. Contrast-Enhanced Computed Tomography (CECT) was done to identify any change in the position of the needle and confirm its position three-dimensionally. The image revealed a change in the orientation and angulation of the needle compared to the previous radiograph (Fig. 2), indicating migration of the needle.

Fig. 2.

Radiograph showing the migrated needle position (white arrow)

Following three-dimensional localization of the needle using CECT, the patient was planned for needle retrieval under general anesthesia. Intraoral palpation was done to confirm the location, and an incision of about one centimeter was placed over the dorsal surface of the tongue. Gentle, blunt dissection was done using the artery forceps keeping in mind not to displace the needle. A needle of size three centimeters was retrieved carefully (Fig. 3), hemostasis was achieved and closure was done in layers with 3–0 resorbable sutures. The post-operative period was uneventful and the patient was advised oral antibiotics and analgesics. On follow-up, the patient was asymptomatic and the surgical site healed satisfactorily with no neurological deficit.

Fig. 3.

Retrieved needle

Discussion

Penetration of a foreign body into the tongue is rare. Literature is scarce about traumatic or iatrogenic needle penetrations and the sequence of procedures in the management of such rare scenarios. In such a situation, proper examination and diagnosis with careful execution are required to avoid unwanted complications. Misdiagnosis or delayed diagnosis can lead to severe infection and sometimes result in mortality. Clinical examination should include meticulous inspection for entry points, intraoral palpation without displacing the foreign body, and the use of Computed Tomography (CT) for three-dimensional localization. Additional investigations like Magnetic Resonance Imaging and ultrasonography can be helpful [7]

The tongue is a highly vascular organ [8] Hence, vague exploration would lead to sublingual hematoma which in turn leads to airway obstruction and death. Sound knowledge of anatomy would aid in the assessment of the proximity of foreign bodies to neurological and vascular structures, thereby, preventing untoward complications. Many authors suggest the immediate removal of foreign bodies to prevent situations like migration and damage to vital structures [4]. It also relieves the patient from discomfort and difficulty in swallowing. The anterior portion of the tongue being mobile during various activities by itself promotes displacement, patient's anxiety, and restlessness further add complexity leading to migration of the foreign body. Hence, prompt intervention, anxiety management, assurance, and early retrieval would prevent catastrophic events. Although few cases of foreign body in tongue have been reported in the literature, to the best of our knowledge, this is the first case of foreign body migration in tongue to be reported in the literature.

Conclusion

Our case emphasizes the need for detailed evaluation and prompt management of embedded foreign bodies to avoid complications such as aspiration and airway restriction. Head and Neck Surgeons should possess sound anatomy of the region to take utmost care during examination and intervention to prevent any iatrogenic injury to neurovascular structures due to sharp objects like needles. CT is the gold standard to determine the exact three-dimensional location in addition to two-dimensional baseline radiographs in suspected cases of foreign body migration.

Author Contributions

All authors contributed equally to the publication.

Funding

The authors did not receive any external source of funding.

Declarations

Conflict of interest

The authors declare no conflict of interest.

Consent for publication

Written informed consent was obtained from the patient for case photos and publishing purposes.

Ethics Approval

Ethical approval was not necessary for the preparation of this article.