A Rare Case of Successful Perioperative Management of a Child With Oropharyngeal Sharp Foreign Body Penetrating the Brain stem: A Case Report

BACKGROUND: Penetrating foriegn bodies extending into brain stem are rare in children and present unique anesthetic and surgical challenges. Airway management is particularly difficult because of restricted oral access, risk of displacement leading to catastrophic hemorrhage and neurological complications. CASE: We describe the perioperative management of achild who presented in emergency with accidentally impacted foriegn body. The metallic foriegn body occupied the oral cavity significantly limiting the airway access and posing a risk of airway obstruction. A multidisciplinary team involving neurosurgeons, anesthesiologists and otolaryngologists was adopted. Tracheostomy under sevoflurane anesthesia with bag mask ventilation, provisions for major intracranial bleeds (due to proximity to basilar and vertebral vessels), postoperative infection control and a properly planned staged decannulation leds to an uneventful recovery without any major sequelae.