Hypopharyngeal Extrusion of 2.5 Feet (76 cm) of Polytetrafluoroethylene (Gore-Tex): Initial Laser-Assisted Office-Based Removal and Micropharyngeal Completion

Abstract

Extrusion of an implant after medialization laryngoplasty is unusual and warrants removal. Most commonly, it extrudes through the laryngeal introitus, but rarely, it extrudes through the pyriform sinus. A case report in which 2.5 feet (76 cm) of polytetrafluoroethylene (Gore-Tex) was removed from an 80-year-old female patient is presented to evaluate factors that led to this surgical complication and strategies that solved the problem. Because of the patient's multiple medical problems, initial removal of the foreign body was attempted in the office with topical anesthesia. When the Gore-Tex was noted to be lodged in the laryngeal parenchyma, it was severed at the edge of the pyriform sinus to stabilize the airway. Subsequently, microlaryngoscopic-controlled completion removal was done in the operating room with general anesthesia. The patient healed uneventfully with no further sequelae. Analysis of this case illustrates a number of factors leading to a rare iatrogenic foreign body complication. Office-based removal of the Gore-Tex implant evolved into a unique scenario in which the rapid use of a fiber-based laser to divide the foreign body facilitated stabilizing the airway to allow for elective completion removal in a controlled fashion.