Objective: To determine the accuracy of plain lateral neck radiograph in diagnosis of foreign body [FB] in oropharynx, hypopharynx, and cervical esophagus.

Materials and Methods: A prospective study was done on 57 patients presented with suspicion of FB ingestion. Plain lateral neck radiography was done in all patients. The patients received complete ENT examination of oral cavity and pharynx and FB was removed under local anesthesia if the FB was found. If the FB could not be found in oral cavity or pharynx and the patients still had symptoms suspicious of FB impaction or FB in esophagus or presence of radiographic finding of FB, direct laryngoscopy and/or rigid esophagoscopy under general anesthesia would be done to determine the presence of FB in hypopharynx or cervical esophagus.

Results: FB was found in 47 out of 57 patients, 23/47 (48.9%) at oropharynx, 9/47 (19.1%) at hypopharynx, and 15/47 (31.9%) at cervical esophagus. Overall sensitivity and specificity of plain lateral neck radiography to diagnose FB at oropharynx and hypopharynx or cervical esophagus was 44.68% and 90%, respectively. However, the accuracy of plain lateral neck radiograph in diagnosis of FB in hypopharynx and cervical esophagus (combined sensitivity 58% and specificity 100%) were satisfactory and higher than oropharynx (sensitivity 30% and specificity 90%). The 23 oropharyngeal FB could be found by oral and pharyngeal examination with 21 being removed at the clinics under local anesthesia.

Conclusion: Lateral neck radiography has higher detection rate for ingested FB that lodged in the hypopharynx or esophagus than in the oropharynx. It should be done after negative oral and pharyngeal examination, which most of the oropharyngeal FB could be found and removed. Appropriate direct laryngoscopy and/or rigid esophagoscopy should be considered according to the clinical symptoms and results of plain lateral neck radiography.

Keywords: Lateral neck radiograph, Foreign Body, Sensitivity, Specificity