FOREIGN BODIES OF AIR

PASSAGES
DƯƠNG THỊ MỸ

Disease of Ear, nose and throat and head and neck surgery
 CONTENTS

I. AETIOLOGY
II. NATURE OF FOREIGN BODIES
III. CLINICAL FEATURES
IV. DIAGNOSIS
V. MANAGEMENT
I. AETIOLOGY
- Children
 < 4 years (> 50%)
 Vegetable
Nonvegetable matters
I. AETIOLOGY
- In adults:  foreign bodies are aspirated
during coma, deep sleep or alcoholic
intoxication
 loose teeth or denture may be
aspirated during anaesthesia.
II. NATURE OF FOREIGN BODIES
FOREIGN
BODIES
Nonirritating
Irritating type.
type

diffuse violent
reaction congestion

symptomless for a vegetal bronchitis

long time

oedema
swell up

airway obstruction

suppuration in the lung

 III. CLINICAL FEATURES
be coughed out
1. Initial period of
choking, gagging Fb
and wheezing Lodge in the larynx
or further down in the
tracheobronchial tree
lasts for a
short time

2. Symptomless
interval

size airway
Last a few obstruction
hours
or a few weeks
nature inflammation

site of its
3. Later symptoms trauma induced
lodgement
by the Fb
III. CLINICAL FEATURES
3. Later symptoms

Complete sudden
obstruction death

Laryngeal discomfort or pain

Fb in the throat

Partial hoarseness, croupy

obstruction cough, aphonia,
dyspnoea, wheezing

haemoptysis
III. CLINICAL FEATURES
3. Later symptoms

cough and
A sharp Fb haemoptysis

Tracheal
Fb

audible slap” and

A loose Fb “palpatory thud
 III. CLINICAL FEATURES
3. Later symptoms
Bronchial Fb

One way Total One way

Partial obstruction obstruction
obstruction
obstruction (stop valve) (reverse of B)
(Ball-valve effects)

obstructive atelectasis
wheeze emphysema atelectasis
IV. DIAGNOSIS
DIAGNOSIS

physical
History
examination

Children with sudden diminished

wheezing, stridor, onset of entry of air
cough, asthma, coughing, into the
recurrent chest wheezing lungs
infections being
treated with steroids
and antibiotics
classical
triad

Radiology
IV. DIAGNOSIS
2. Radiology
IV. DIAGNOSIS
2. Radiology
IV. DIAGNOSIS
2. Radiology
IV. DIAGNOSIS
2. Radiology
IV. DIAGNOSIS
2. Radiology
IV. DIAGNOSIS
2. Radiology
IV. DIAGNOSIS
2. Radiology
IV. DIAGNOSIS
2. Radiology
Fluoroscopy/videofluoroscopy
V. MANAGEMENT

Laryngeal Fb

should not be done if

patient is only
partially obstructed

Heimlich
manoeuvre

Cricothyrotomy or
emergency
tracheostomy

Direct laryngoscopy
or by laryngofissure
V. MANAGEMENT
Heimlich manoeuvre
V. MANAGEMENT
Heimlich manoeuvre
V. MANAGEMENT
5.2. Tracheal and bronchial foreign
bodies: Bronchoscopy
+ Not emergency
+ unless there is airway obstruction or they
are of the vegetable nature and likely to
swell up
.
V. MANAGEMENT
5.2. Tracheal and bronchial foreign bodies
Methods to remove tracheobronchial Fb
1. Conventional rigid bronchoscopy.
2. Rigid bronchoscopy with telescopic aid.
3. Bronchoscopy with C-arm fluoroscopy.
4. Use of Dormia basket or Fogarty’s balloon for rounded
objects.
5. Tracheostomy first and then bronchoscopy through the
tracheostome.
6. Thoracotomy and bronchotomy for peripheral foreign
bodies.
7. Flexible fibreoptic bronchoscopy in selected adult
patients
V. MANAGEMENT
5.2. Tracheal and bronchial Fb
Equipment for Fb removal:
1.Bronchoscope
2. Telescope or optical forceps.
3. Two laryngoscopes.
4. Foreign body forceps, Dormia basket,
Fogarty’s catheter and a syringe to inflate it
V. MANAGEMENT
5.2. Tracheal and bronchial foreign bodies

Ventilation bronchoscope
V. MANAGEMENT
5.2. Tracheal and bronchial foreign bodies
Equipment for Fb removal
V. MANAGEMENT
5.2. Tracheal and bronchial foreign bodies

Optical forcep
V. MANAGEMENT
5.2. Tracheal and bronchial foreign bodies
Equipment for Fb removal

Foreign body forcep

V. MANAGEMENT
5.2. Tracheal and bronchial foreign bodies
Equipment for Fb removal

Dormia basket
V. MANAGEMENT
5.2. Tracheal and bronchial foreign bodies

Flexible fibreoptic bronchoscopy: adult patient

V. MANAGEMENT
5.2. Tracheal and bronchial foreign bodies

Fogarty’s catheter
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