Management of unusual soft tissue foreign bodies in the pediatric neck

Objective: To propose management options for foreign bodies that have migrated to cervical soft tissue in pediatric patients. Methods: Review 2 new cases seen in 2 academic pediatric hospitals and cases in the literature of cervical foreign body in the neck. Results: Case 1 is a 6-year-old boy whose history of an axillary impalement 2 years previously was not elicited until a 2-cm sliver of wood extruded from the neck wound several weeks after an inflammatory soft tissue mass in the neck was explored and biopsied without evidence of a foreign body. Case 2 is a 14-year-old boy who experienced intraoral fracture of a needle during a dental procedure; CT performed 10 months later showed that the needle had penetrated the carotid sheath at the level of the mid-neck, and it was removed operatively using ultrasound guidance. Review of the literature found 2 cases of unusual foreign bodies in the neck that had migrated from noncervical locations [7] and [8], as well as several other reports of foreign bodies that migrated within the cervical region [1], [2], [3], [4], [5] and [6]. Conclusions: Although soft tissue cervical foreign bodies are uncommon and their management defies standardization, the 2 new cases reported here and those in the literature demonstrate the importance of a methodical approach to a pediatric neck mass. Specifically, in new case 1, an understanding of the planes of the neck through which a foreign body in the axilla may migrate and a readiness to use intraoperative ultrasound could have led to location of the foreign body intraoperatively, a management approach that was successful in new case 2 and in the literature reports.