An unusually silent presentation of retained sharp foreign bodies adjacent to the larynx: a case report

Abstract Background External laryngeal trauma is rare but potentially life-threatening. It is most commonly caused by sharp objects. Securing the airway and preserving phonatory function are the primary goals of management. The aim of this paper is to report a rare case of self-inflicted insertion of sharp foreign bodies in the thyrohyoid region adjacent to the larynx, presenting without respiratory or phonatory symptoms. Case presentation A 43-year-old male detainee with a history of bipolar disorder who had discontinued psychiatric treatment following incarceration, was referred to our emergency department after self-inflicted insertion off sharp metallic foreign bodies into the thyrohyoid region adjacent to the larynx. On admission, the patient was hemodynamically stable and asymptomatic, with no dyspnea or dysphonia. Physical examination revealed a subhyoid swelling with a palpable rigid object. No active bleeding or external wound was objectived. Flexible nasofibroscopy showed a normal laryngeal appearance with preserved vocal cord mobility. High-resolution cervical computed tomography (CT) revealed two metallic foreign bodies lodged between the hyoid bone and the thyroid cartilage. Their distal ends extended toward the base of the epiglottis, measuring 30 mm and 37 mm in length. No contrast extravasation, vascular injury, or aerodigestive tract perforation was detected. The patient was admitted for surgical neck exploration under general anesthesia. Airway evaluation combining contrast-enhanced CT and flexible nasofibroscopy demonstrated preserved airway patency, intact laryngeal mucosa, normal vocal cord mobility, absence of airway narrowing, and no intraluminal extension of the foreign bodies. These findings suggested a low risk of foreign body displacement during controlled laryngoscopy and supported video-assisted orotracheal intubation under direct visualization. Surgical exploration via a horizontal cervical incision allowed identification of two metallic rods, one superficial and one penetrating the thyrohyoid membrane. Both were removed without complication. No laryngeal mucosal injury was identified. The postoperative course was uneventful, with preservation of both airway patency and voice quality. The patient was subsequently referred for psychiatric assessment and follow-up. The patient remained eupneic and euphonic throughout the 3-month follow-up period, with no evidence of respiratory compromise or voice impairment. Conclusions Retained sharp foreign bodies adjacent to the larynx may remain clinically silent despite deep tissue involvement. Absence of symptoms does not exclude significant injury. CT imaging, endoscopic evaluation, and individualized airway planning are essential for safe management and functional preservation.