Clinical Cases - Carotid Sheath, Pharynx, & Larynx

A medical student was celebrating the end of midterm exams with her friends in a seafood restaurant when she started feeling a prickling sensation in her neck after swallowing a large bite of smoked fish. The pain was getting worse, and attempts to clear it with drinks failed. At the emergency room a plain X-ray of her neck showed a tiny fish bone lodged in the lower part of the pharynx. The bone was quickly removed under general anesthesia, and the patient was discharged a few hours later.

Questions to consider:

1. Which are the most usual places for swallowed foreign bodies to be lodged?
   

   The piriform recess and the valleculae on either side of the median glosso-epiglottic fold.

2. What is the piriform recess?
   

   This is a small, pear-shaped depression of the laryngopharyngeal cavity on each side of the inlet of the larynx. It is separated from the inlet by the aryepiglottic fold. Laterally the piriform recess is bounded by the medial surfaces of the thyroid cartilage and the thyrohyoid membrane. The branches of the internal laryngeal and inferior laryngeal nerves (continuation of recurrent laryngeal) lie deep to the mucous membrane of the piriform recess.

3. Fish bones and other foreign bodies may pierce the mucous membrane of the recess and cause injury to the internal laryngeal nerve. What are the possible consequences of this injury?
   

   Injury to the internal laryngeal nerve will result in anesthesia of the laryngeal mucous membrane as far inferiorly as the vocal folds.