Migrated ingested foreign bodies in the aerodigestive tract can lodge within vital organs and vessels, causing potentially devastating complications. It is often difficult to localise these foreign bodies, with extrication resulting in the requirement for open approaches which may cause significant morbidity.

This paper presents the case of an ingested migrated stingray bone lodged adjacent to the vertebral artery in the upper cervical spine. This was managed via an endoscopic transoral approach, with the assistance of an image-guidance system.

Successful extraction of the foreign body was achieved, with minimal residual morbidity.

Our study showed that image-guided endoscopic surgery is a safe, precise and feasible option for the localisation and removal of migrated foreign bodies in the aerodigestive tract involving critical neurovascular structures.

Ingested foreign bodies are common emergencies encountered in otolaryngology practice. The vast majority can be managed with endoscopic removal. Migration of foreign bodies into the paraglottic space is a rare event that often necessitates using a more invasive procedure for removal.

A 68-year-old man presented with sore throat and odynophagia 4 days after ingesting a fish bone.

A computed tomography scan revealed a 2.5 cm linear foreign body embedded in the larynx within the right paraglottic space. The patient underwent endoscopic examination and transcervical exploration of the paraglottic space via a posterolateral approach, with successful removal of the foreign body on the second attempt.

This is the first case report of an ingested paraglottic space foreign body managed by transcervical exploration using a posterolateral approach to the paraglottic space.