Missing pharyngeal pack endoscopically retrieved: An avoidab
Published in the Annals of Maxillofacial Surgery, the authors report an unusual case of a pharyngeal throat pack inadvertently left behind postextubation. The pack was subsequently identified and retrieved successfully from the gastrointestinal tract.

A 23-year-old male involved in a road traffic accident was brought to the emergency room of our hospital. He was diagnosed of having TMJ fracture. The plan was closed reduction and arch bar placement under general anesthesia (GA). The patient was nasally intubated. The pack was placed by the anesthesiologist. In the operating room, on the white board in bold letters “Throat Pack In” was written along with its time of placement.

Occlusion was achieved and intermaxillary fixation (IMF) was released; the patient was extubated and shifted to the recovery with stable vitals. Nurse informed of an unaccounted pack while erasing the whiteboard. The patient was shifted back to the operation theater. Direct laryngoscopy revealed no signs of pack. A fine suction catheter was passed through the nostrils hoping that the pack was lodged in the nasopharynx. There was free movement of the suction catheter indicating its absence in the nasopharynx.

The pack used was a plain roll gauze, and the use of C-arm to localize was ruled out. With the help of gastroenterologist, endoscopy was performed under sedation. Pack had partly crossed the pyloric sphincter of the gastrointestinal tract. The foreign body was removed endoscopically without complications.

Postoperatively, the family was explained about the missing throat pack. Recovery was uneventful. IMF was done after the patient was alert. The patient was discharged.

Lessons learnt:-
- Missing pack is a life-threatening complication and has medicolegal implications on the operating team.

- A standardized documentary protocol should be used. One who places the pack is responsible for its removal.

- The surgeon should verbally remind the anesthesiologist regarding pending pack. In this case, the surgeon visually saw it but did not remind the anesthesiologist.

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