Fig. 1

Clinical workflow for suspected animal bone impaction. Patients presenting with animal bone impaction will receive direct oral examination followed by laryngeal fiberscope if the oral examination is not revealing. Any bones found will be directly removed during the examination. If no foreign body is detected, then a lateral neck radiograph will be performed. If the foreign body is still not identified, then a CT without contrast medium administration from the tongue base to the stomach will be performed. If the foreign body is detected in the esophagus, either by plain radiograph or CT, then the foreign body will be removed by rigid esophagoscope under general anesthesia or flexible fiberscope under sedation. Bones detected on lateral neck radiograph will exempt the patient from further CT studies unless there are concerns for complication. If no foreign body is detected on CT, then the patient will be discharged if symptoms improve