Management of intraoral needle migration into the posterior cervical space

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Abstract

Foreign bodies within the deep spaces of the neck pose infrequent but substantial risks involving migration, including infection, pseudoaneurysm formation, pneumothorax, hemopericardium, and embolization to the central circulation. A rare case of foreign body migration through the parapharyngeal space into the posterior cervical space is described from an intraoral needle shard. A 48-year-old male presented with a right neck tenderness, referred otalgia, and intermittent neck twitching after a needle fragment was lost during an inferior alveolar nerve block. A CT scan six months after the incident revealed migration of the 2.5 cm needle posterolateral to the great vessels into the posterior cervical space. A transcervical approach led to identification and extraction of the foreign body, with resolution of symptoms. Sharp foreign bodies in the head and neck introduce an uncommon but high-impact risk of complications. Migration is often unpredictable in trajectory and time course. Early surgical removal is recommended for persistent symptoms, sustained migration, and localization to sites with critical structures.

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