Rare Migrated Fishbone Foreign Body in the Nasopharynx

Although impaction of the pharyngoesophageal fishbone represents a common otolaryngological emergency, migration of an ingested fish bone into the nasopharynx is an extremely rare clinical occurrence. We present a 57-year-old woman who developed acute odynophagia one hour after fish ingestion, accompanied by a single choking episode, in the absence of nausea or vomiting. The oropharyngeal examination at the bedside failed to identify any foreign body. Given the patient's refusal to computed tomography (CT), she was discharged for outpatient surveillance. Twenty-four hours later, she returned with persistent refractory pharyngeal pain. Repeated pharyngeal endoscopy revealed neither foreign material nor mucosal injury. Multiplanar coronal CT reconstruction identified a 2.63 cm linear hyperattenuating bone fragment within the nasopharyngeal cavity. After topical nasal decongestion, flexible fiberoptic nasopharyngoscopy confirmed a partially embedded migrated fish bone, which was successfully retrieved endoscopically using alligator grasping forceps. Odynophagia resolved immediately after extraction and the patient remained asymptomatic throughout the 2 week follow-up. For patients with persistent pharyngeal pain and high clinical suspicion of retained foreign bodies despite negative physical examination and endoscopic findings, CT should be considered the first-line cross-sectional modality to prevent missed.diagnoses and life-threatening cervicofacial septic complications.