Laryngotracheal foreign body: chicken neck bone

Laryngotracheal foreign body (LTFB) aspiration presents as an emergency, and unless diagnosed and treated promptly, a fatal outcome is almost inevitable.1 The diagnosis of occult LTFB aspiration is complex.2 The symptoms are related to the nature, size, location, and time of aspiration of the LTFB.3 Although less common than bronchial foreign bodies, LTFBs are potentially dangerous.4,5 Studies analyzing adult patients have shown that a normal swallowing reflex protects against foreign body aspiration. Some types of central nervous system dysfunction may increase the risk of foreign body aspiration: stroke, loss of consciousness, metabolic encephalopathy, alcoholism, intellectual disability, neurological and/or psychiatric diseases, seizure disorders, consumption of central depressant drugs, inhibition of the pharyngeal or cough reflex, and other disorders.6–9 Asphyxia may also develop in some patients.10–12 In the present case, a patient with severe congenital intellectual disability exhibited no signs or symptoms of LTFB aspiration. Computed tomography revealed almost complete laryngeal obstruction due to an inanimate LTFB (chicken neck bone). Laryngeal spasm secondary to foreign body aspiration contributes to the development of asphyxia, and the effort of yelling or swallowing facilitates penetration of the foreign body into the larynx and trachea while the coughing reflex becomes inefficient.13 This case is being reported because the findings could have a great impact on taking the patient’s mental condition into consideration in the presence of severe laryngeal obstruction, helping to prevent progression to agitation, suffocation, and a fatal outcome.