Combination of preoperative three-dimensional computed tomography and intraoperative ultrasound-assisted foreign-body extraction in the tongue: A case report

Foreign bodies (FBs), such as fish bones, are commonly found in the upper aerodigestive tract, particularly the palatine tonsils and tongue. Detecting FBs embedded in the tongue's muscle layer is challenging using visual inspection alone. Although preoperative computed tomography (CT) is effective for detecting FBs, two-dimensional images often fail to provide a clear understanding of the shape, position, and angle of the FB. Thus, we used preoperative three-dimensional CT (3D-CT) combined with intraoperative ultrasound to significantly enhance detection and localization. A 50-year-old man presented with pain on the right edge of his tongue after eating fried fish. Although palpation revealed a tender area, no FB was detected initially. Plane CT showed a hyperabsorptive area in the tongue, whereas 3D-CT revealed a 24-mm curved fish bone located approximately 10 mm beneath the surface. Preoperative 3D imaging and intraoperative ultrasound before emergency excision played a critical role in confirming the precise location of the FB. The fish bone was successfully removed, matching the predictions made by the 3D-CT, and the patient experienced no postoperative complications. • Identifying a foreign body in the tongue is like searching for a needle in a haystack. • Preoperative 3D-CT and intraoperative ultrasound combined enabled precise localization of the foreign body in the tongue. • Accurate identification of the foreign body location preoperatively and intraoperatively leads to a successful surgery.