Endoscopically Assisted Removal of a Fish Bone Penetrating the Parotid Duct: An Unusual Case

PurposeThe aim was to evaluate the efficacy of endoscopy-assisted surgery for treating a foreign body (fish bone) deeply embedded in the parotid duct.Patients and MethodsWe report the case of a 67-year-old man with diffuse swelling of the cheek and the discharge of pus from the parotid duct orifice caused by a fish bone that had penetrated into the parotid duct. The preoperative examination using ultrasonography and computed tomography showed a linear foreign body.ResultsThe fish bone was thought to be embedded deeply in the parotid duct; therefore, we used a combined approach (endoscopy with open surgery), because we anticipated difficulties with endoscopic removal of the fish bone. The endoscopic view showed that the fish bone had partially penetrated the soft tissue in the parotid duct wall, but the fish bone could not be removed endoscopically. With endoscopic assistance, the impacted fish bone was removed using an intraoral surgical approach. The clinical outcome was satisfactory during a 10-month follow-up period, with no evidence of complications.ConclusionsThe combined surgical and endoscopic approach resulted in the safe and effective removal of a foreign body from the salivary duct that could not be removed using sialendoscopy alone.