We encountered a case with a very small metallic foreign body inside the parapharyngeal space which was removed via the transoral approach.

The patient was 36-year-old man living on a remote island. He visited the island’s clinic with a sore throat that he developed after eating fish soup. But his symptoms disappeared soon thereafter. However, the throat pain recurred after two months, and CT revealed a small foreign body inside the parapharyngeal space; the patient was immediately referred to our institution for removal of the foreign body. Since there was no abscess observed on the overlying skin and the location of the foreign body inside the parapharyngeal space could be well identified on the CT images, we attempted to remove it via a transoral approach without incising the skin. Intraoperative radiography and ultrasound were very useful to identify and remove the foreign body. However, the navigation system that we frequently use for operations of the nasal-paranasal sinuses was not as useful as we thought in this case.

The transoral approach is less invasive for the patient. If there is no inflammation or abscess in the affected area and the target foreign body can be identified before or during the operation, this approach may be of some advantage over the external incision method.