Embedded Fishbone Foreign Bodies in the Tongue: Clinical Characteristics and Treatment Strategies: A Retrospective...

Lingual fishbone foreign bodies completely embedded in the deep lingual musculature present significant surgical challenges due to imprecise preoperative localization and the risk of iatrogenic injury to neurovascular structures. However, the current literature on this condition consists predominantly of isolated case reports, lacking comprehensive systematic investigations.

The aim of the study is to characterize the clinical presentations of embedded lingual fishbone foreign bodies and propose a practical, depth-based classification system to optimize tailored surgical management.

This retrospective study included all patients who underwent treatment for embedded fishbone foreign bodies in the tongue at our hospital between October 2013 and October 2024. Demographic data, clinical presentations, characteristics of the fishbone foreign bodies, and treatment outcomes were systematically analyzed to summarize treatment strategies.

A total of 22 cases (ages 37-77 y; equal gender distribution) were included. The predominant symptoms were tongue swelling, pain, and discomfort. All foreign bodies were intermuscular bones, appearing as small, needle-like hard spicules ranging from 1 to 3 cm in length. On the basis of preoperative imaging, the fishbone foreign bodies were classified by depth into 3 types: (1) superficial (adjacent to the tongue surface, n=11); (2) intramuscular (embedded within the intrinsic tongue musculature, n=10); (3) sublingual (extending toward the floor of the mouth, n=1). All fishbone foreign bodies were successfully removed using an approach tailored to the specific location.

Although relatively uncommon, lingual fishbone foreign bodies predominantly affect middle-aged and elderly populations. The proposed depth-based classification serves as a crucial preoperative diagnostic tool. It accurately dictates the appropriate surgical strategy, facilitating precise foreign body retrieval while minimizing surgical trauma to the complex tongue musculature.