Comparative Outcomes of Transoral Versus Transcervical Approach for Extrapharyngeal Foreign Body Removal

ABSTRACT Objective This retrospective study compares clinical outcomes between transoral microlaryngoscopy and transcervical approaches for extra‐pharyngeal foreign body removal. Methods Clinical data from 21 patients with extracavitary foreign bodies located in the retropharyngeal and parapharyngeal spaces were retrospectively analyzed. These patients attended the Department of Otolaryngology at Nanfang Hospital between March 2017 and July 2023. Patients underwent either transcervical or transoral microlaryngoscopic removal based on preoperative CT localization. Statistical comparisons for categorical variables used Fisher's exact tests, while continuous variables were compared using independent T ‐tests. Continuous non‐normally distributed variables were compared with the Mann–Whitney U test (significance: p < 0.05). Results Of the 21 patients, 7 (33.3%) required two or more surgeries under general anesthesia, and in five cases (23.8%), the foreign body was not removed. Eight patients underwent cervical incision surgery, while 13 underwent transoral procedures. Hospital stays were shorter in the microlaryngoscopy group (1–6 days, mean 3.8 ± 1.6) compared to the cervical incision group (5–22 days, mean 14.9 ± 8.7, p < 0.05). Operation times averaged 66.8 ± 43.8 min for microlaryngoscopy and 170.8 ± 93.2 min for cervical incision ( p < 0.05). Hospitalization costs were significantly lower for the microlaryngoscopy group (mean RMB 10,470.50 ± 3256.26) compared to the cervical incision group (mean RMB 33,328.93 ± 19,057.29, p < 0.05). No tracheostomies or complications occurred in the microlaryngoscopy group (0/13, 0%). In contrast, three cervical incision patients (37.5%) required tracheostomies, and three experienced complications ( p < 0.05). Conclusion Transoral approach demonstrates superior outcomes for accessible extra‐pharyngeal foreign bodies. Preoperative CT localization critically informs surgical strategy selection. Level of Evidence 4.