[Removal of multiple foreign bodies from the head region via endonasal, transoral, and transcutaneous approaches].

In Hungary, the incidence of firearm-related injuries is low; consequently, domestic clinical experience and the number of published cases remain limited, which makes the selection of appropriate diagnostic and therapeutic strategies particularly difficult. Small lead pellets from shotguns easily penetrate tissues and, due to their tendency to migrate along tissue planes, can significantly complicate both localization and surgical removal. They may cause serious complications, including neurovascular injury, chronic lead poisoning, or infections such as abscess, sepsis, and meningitis. The head and neck region is particularly critical, as the proximity of the skull base, major vessels, and airways demands increased caution during interventions. Management of foreign bodies in the nasopharyngeal space presents an additional challenge, given their rare occurrence in adults and the limited documentation in the literature. Conventional imaging often does not provide sufficient accuracy, making intraoperative image guidance essential for safe removal. This study presents the case of a 34-year-old male who sustained multiple head and neck injuries during a hunting accident, in which a shotgun was fired from approximately 30 meters. The patient was managed in a multidisciplinary setting, with collaboration between ophthalmology and otorhinolaryngology specialists. We describe the successful removal of four 2-3 mm lead pellets under intratracheal anesthesia, using intraoperative C-arm fluoroscopic guidance and a multimodal approach (endonasal, transoral, and transcutaneous), highlighting the endoscopic extraction of the pellet localized in the epipharynx. This case emphasizes the importance of precise imaging, minimally invasive surgical techniques, and multidisciplinary cooperation in order to achieve a safe management of head and neck foreign bodies. Orv Hetil. 2026; 167(21): 842-847.