FOREIGN BODY AERODIEGSTIVE TRACT FOR UNDERGRADUATES

FB AE TRACT

1. FOREIGN BODIES
UPPER AERO-DIGESTIVE TRACT

2. INTRODUCTION
DEFINITION = a substance not normal
to the place where it is found
Exogenous
Endogenous: eg. mucous plugs
Otolaryngologist, Chest surgeon,
Chest physician, Pediatrician, Gastro-
enterologist

3. FB-in Airway: Incidence
Commonest cause of accidental death
at home in children under 06 yrs
Maximum between 01 and 03 yrs
Boys : girls –2:1
Only 04 % impact the larynx

4. History
Choking,paroxysmal coughing,
then subsides -delay in diagnosis!
Wheeze
Unexplained persistentfever
Persistent lobarpneumonia
Pain
Ac respiratory distress
-uncommon

5. Clinical Examn
Unilateralexpiratory wheeze, reduced
air entry
Pneumonic signs
After 24 hrs
More in Vegetable origin FB (intense
inflammatory reaction)
Atelectasis
Dry, Vegetable FB (swelling by hygroscopic
action)
Hemoptysis

6. Site of FB
Sharp –in tonsil, vallecula
Smooth in Larynx, trachea,
Bronchi
Majority in Rt bronchial tree
Wider
Angulation is less
More equal distribution in
children

7. Radiography
Neck extended, AP & Lat views
Chest X Rays in Insp & Exp
Lat Chest Ray
Findings in about 90 %
CT Scan / MRI

8. Obstructive Emphysema
Ball –valve
mechanism

9. Obstructive emphysema -Lt

10. Management
Heimlich maneouvre
OPD removal
Rigid Endoscopic removal
Usually GA
Flexible FO Scopy
Usually LA
Tracheostomy
Thoracotomy
Antibiotics
Chest Physiotherapy

11. Prevention
Children under 02 yrs should not be
allowed to eat peanuts
Their play areas & toys should not
have small parts that can be inhaled
Adults should not place pins etc in
their mouths

12. FB -Oesophagus
Coins, Bones, Safety Pins, Lumps of
Meat
Incidence rises in old age
Not chewed properly
Ineffective oesophageal propulsion
Dentures may be swallowed

13. Sites
Crico-Pharyngeal sphincter
95 %
Hiatus
Level of Arch of aorta
At strictures

14. Presentation
Dysphagia
Pain & Discomfort
Increased salivation
Mediastinitis
Airway symptoms

15. Radiography
Radio-opaque FB
Non Rdio-opaque FB
Ba Swallow
CT Scan / MRI

16. Examn
Swelling
Surgical Emphysema
Observation
? Increased dysphagia & pain
Abrasion -subsides

17. Management
Rigid Endoscopic removal
Flexible FO endoscopic removal
Passage per rectum