Robotic-Assisted Removal of Wire Bristle in Tongue Base

A 26-year-old nonsmoker male patient presented to emergency department with the complaint of severe sharp throat pain he experienced while he was eating hamburger. Further questioning revealed that he had been cleaning his grill with a wire bristle brush prior to cooking. He denied shortness of breath, hoarseness, or hemoptysis. A soft tissue neck X-ray revealed what appeared to be a wire bristle in the base of the tongue. He was transferred to a larger community hospital, where the flexible laryngoscopy suggested the tip of a small wire protruding from the tongue base which was difficult to visualize. The Ear, Nose and Throat (ENT) surgeon recommended laryngoscopy under general anesthesia for removal of foreign body. In operation room (OR), after adequate anesthesia with intermittent mask ventilation, the Kleinsasser operating laryngoscope and a 0 rod lens endoscope through the laryngoscope was used, but foreign body was not visible in the tongue base. The patient was then intubated for a deliberate examination; however, neither the foreign body nor the site of entry could be visualized. Lateral fluoroscopy, anterior–posterior fluoroscopy, or bimanual examination did not help. The surgeon terminated the procedure. Computed tomography (CT) revealed the wire was still in the tongue base (Figure 1), lying from posterior–inferior to anterior– superior. The tip of the wire was laying deep to the mucosa. The ENT surgeon contacted the author and proposed a transoral robotic surgical procedure to remove the foreign body. In the referral hospital OR, after nasotracheal intubation, a self-retaining retractor was placed in the oral cavity. The left tongue base was exposed. The robot was brought into position and docked. Using a 30 scope, a mucosal flap was developed in the left base of tongue near vallecula. Dissection proceeded in the submucosal plane. A wire bristle was seen in the base of the wound (Figure 2) and was extracted using the Maryland forceps. The redundant mucosal flap was excised. Hemostasis was verified. The patient was awakened, extubated, and taken to the Post-Anesthesia Care Unit (PACU) in stable condition having tolerated the procedure well.