Removal of Foreign Body (Glass of Mirror) in Esophagus with Direct Laryngoscope

Literature contains fewer reports discussing the use of direct laryngoscope in esophageal foreign body extraction. Foreign bodies in esophagus was diagnosed based on anamnesis, physical examination, radiological finding. The choice of treatment influenced by many factors, such as the patient’s age and clinical condition, the size and shape of the ingested foreign body, the anatomic location and the skills of the physician. A case of impacted glass of mirror in esophagus and mental disorder in a 38 years old male was reported, which had been perfomed direct laryngoscope and an extraction with Magill forcep.


INTRODUCTION
Patients with foreign bodies in the upper gastrointestinal tract commonly present to the otorhinolaryngology emergency for evaluation. The foreign bodies involved differ in children and adults.
Children typically ingest object they pick up and place in their mouth. In contrast adult are more prone to ingest food boluses, chicken or fish bone, dentures, or toothpick.Variety object was found in prisoner and psyciatric patient. 1,2 People with derranged mental status might ingest a foreign body that might get stuck for prolonged period as a negleted one. Their clinical presentation may be delayed and may include multiple foreign bodies. Pica, or the compulsive ingestion of nonfood articles, may be common in those with serious mental impairment or developmental delay.
These patients are at risk of complications from expectant management of foreign body ingestion. 3,4 Additionaly, the literature contains fewer reports on this topic that focus on psyciatric issues involved.
Negleted foreign bodies are also not uncommon in the pediatric population. Children having the common habit of putting things in their mouth will swallow the foreign body that might get stuck in the esophagus without being noticed by the parent. 3 Mirrors are commonly used for personal grooming or admiring one self (in which case the archaic term looking-glass is sometimes still used), decoration, and architecture. Glass of mirror are object that are rarely found in the case of foreign bodies impaction at esophagus. Physically glass is solid with smooth surfaces. common household glass is composed of 60-75% silica, 12-18% soda, and 5-12% lime and as such is radiolucent. This was why the Case Report radiopacity on the radiograph created diagnostic doubts. 5 A glass of mirror is a silvery-coated household glass and in this case the silver nitrate coat acted as a "radiologic marker" thus aiding easy identification (via prevertebral soft tissues on plain xrays) of the level of impaction, and subsequent removal. 5 The physical findings and symptoms of aspirations caused by foreign body was vary, depending on the location, tissue reaction, the size, the form, and the constitution of the object. 6 Impacted foreign bodies in the esophagus can easily cause mucosal ulceration, inflammation or even infections and can also result in various fatal complications such as para or retroesophageal abscess, mediastinitis, empyema, perforation or even esophago-aortic fistula. 7 The main symptoms of patients complained of were difficulty in swallowing, acute onset of pain, dysphagia and excessive salivation. 7 It is usually presented with dysphagia or inability to swallowed the saliva in children, and is often mistaken from odynophagia, symptoms such as pain in the retrosternal region and the back, angina pectoris, and cardiovascular injuries. Additional findings may be present in case of complications. 3 Physical examination may be normal in as many as 90% of patients with esophageal impaction.
Rare findings on physical examination include; fever, pharyngeal erythema, palatal abrasion and subcutaneous emphysema suggestive of esophageal perforation. 5 The best modality of foreign body removal has been a subject of much controversy for years. 6,7 The choice of treatment is influenced by many factors, such as the patient's age and clinical condition, the size and shape of the ingested foreign body, the anatomic location and the skills of the physician. 7 Endoscopy is currently the most commonly used method for removal. impaction. 6 Self-injurious behavior is fairly common in patients with severe personality disorders, posttraumatic stress disorder, and some psychotic disorders.
In patients with personality disorders, intentional ingestion is a form of self-injury. These behaviors are usually nonsuicidal and are considered to be parasuicidal in intent (ie, the ingestion is not done with the intention to die but due to a number of other psychological processes). Self-injury can be an expression of rage toward oneself and/or caregivers, punishment for oneself and/or others, or a way to force others to provide care. 10 Atluri 11  Radiological finding in this case was found radio opaque at level cervical III-VII. Lodgment of foreign body most commonly just below the cricopharyngeus and follow in the thoracic esophagus at the compression of the esophagus by the aortic arch or left bronchus or at a stricture. 1,11 The diameter of the esophagus is reduced at four points: the cricopharyngeus, the crossing of the aorta at 25 to 30 cm from the incisors, the crossing of the left bronchus, and the hiatus at the diaphragm. 12 Ashoor 15  and at the cardioesophageal junction in 17%. 4 Physically glass is solid with smooth surfaces. common household glass is composed of 60-75% silica, 12-18% soda, and 5-12% lime and as such is radiolucent. This was why the radiopacity on the radiograph created diagnostic doubts. A glass of mirror is a silvery-coated household glass and in this case the silver nitrate coat acted as a "radiologic marker" thus aiding easy identification (via prevertebral soft tissues on plain x-rays) of the level of impaction, and subsequent removal. 5 In this case there is part of radiopaque of mirror in radiological examine was showed.
In extraction of foreign body, choice of instrument is crucial factors. Rigid esophagoscope is technique commonly used to extract foreign body, with success rate 80%. 6 The most commonly used method for removal of impacted foreign bodies in the esophagus is rigid endoscopy, which was described in 1937 by Jackson and Jackson.  Those with foreign bodies impacted for more than 24 hours were 14.1 times more likely than those with foreign bodies impacted for less than 24 hours to have a major complication. 15 In this case glass mirror extraction was performed in more than 24 hours after impacted. 16 Complication of rigid esophagoscope can minimilize when extraction performed in 24 hours after impaction. 7 Shinghals reported 89% patient came to hospital in 24 hours. Complication in adult 18% was more than children 8.8%. 10 It estimate esophagus perforation occur 0.34% with mortality 0.05%. 12 The natural history of an untreated impacted foreign body in the adult is poor, with complications such as esophageal perforation, mediastinitis, fistula formation and development of a pleural empyema resulting in mortality figures as high as 50%. 17