Fish is one of the major sources of protein among Malaysians. This has made incidents of fish bones lodged in the throat fairly common clinical problems. Plain radiograph, which is the first line of imaging in such cases, has been reported to have low sensitivity. Besides the location, the degree of radio-opacity of the bone is another important factor and is species dependent. This study was undertaken to determine the radio-opacity of bones from commonly consumed fish in Malaysia. A total of 15 types of fish were identified, six of them were opaque even when embedded and three were visualized in the simulated airway. In terms of radio-opacity, the commonly consumed fish in Malaysia possessed opaque bones and this fact can help doctors identify the location of the foreign body in the throat.
Teratoma of the tongue is a rare entity. We present a male newborn with massive lingual teratoma and cleft palate, which surprisingly did not cause immediate airway obstruction. This case illustrates a huge mass in the oral cavity, which was missed on antenatal ultrasonography because it did not present with polyhydramnios. The mass was excised under general anaesthesia. Histopathologically, it consisted of all three layers of embryonic elements with predominantly glial tissue. Postoperatively, the patient developed hypoglossal nerve palsy, and no recurrence was detected after four years.
A case of a 21 year old gentleman is described, with no history of preceding trauma, presenting with intermittent dysphagia to solids and fluids for 4 years. Neck examination at rest was normal. However on deep inspiration, the right thyroid lamina protrudes or becomes more prominent. The patient is able to return the larynx to its normal position with manual manipulation. Laryngeal examination with fibreoptic scope during rest and deep breath shows gross rotation of the laryngeal structures for more than 60 degrees on deep breath, with the vocal cords axis rotated to the left side. Management was conservative.