Forensic body in Aerodigestive tract

1. FOREIGN BODY IN THE
AERODIGESTIVE TRACT
Presented by:
Manash Pratim Chaliha (31)
Sukmoon Firoja Barbhuiya (32)
Mousomi Mandal (33)
Mriganka Baishya (34)
Parmita Chettri (35)

2. INTRODUCTION
• A Foreign Body is any object in a region it is
not meant to be, where it can cause harm by
its mere presence if immediate attention is
not sought.

3. CLASSIFICATION OF FOREIGN BODY
• Endogenous and Exogenous foreign bodies
• Irritant and Non-irritant foreign bodies

4. ANATOMY OF
AERODIGESTIVE TRACT
• The combined organs and tissues of the
respiratory tract and the upper part of the
digestive tract

5. SAGITTAL SECTION OF HEAD AND
NECK

6. LATERAL WALL OF NASAL CAVITY

7. NASAL CAVITIES

8. ENDOSCOPIC VIEW:PALATINE TONSIL

9. ENDOSCOPIC VIEW
SHOWING PYRIFORM FOSSA

10. PHARYNX OPENED FROM BEHIND

11. CORONAL SECTION OF LARYNX

12. PAEDIATRIC LARYNX
• The larynx of a infant differs considerably from
that of an adult
1)Infant’s larynx is positioned high in the neck
2)The diameter of cricoid cartilage is smaller than
the size of the glottis, making the subglottis the
narrowest part.

13. 3) Thyroid cartilage in an infant is flat. It also
overlaps the cricoid cartilage and is itself
overlapped by the hyoid bone.
Thus, cricothyroid and thyrohyoid spaces are
narrow and not easily discernible as
landmarks when performing Tracheostomy.

14. LOWER RESPIRATORY TRACT

15. UPPER OESOPHAGEAL SPHINCTER

16. LEVEL OF NORMAL CONSTRICTIONS IN
OESOPHAGUS:

17. ETIOLOGY OF FOREIGN BODY IN AIR
PASSAGE
• Foreign body in the nose are not uncommon.
• Children are more affected (below 4 years).
-Hygroscopic foreign body.
-Non hygroscopic foreign body.

18. ETIOLOGICAL FACTORS
1. Accidental
2. Penetrating
3. Infection
4. Malignancy

19. SYMPTOMS OF FOREIGN BODY IN
NOSE
• Difficulty in breathing through the affected
nostril.
• Irritability
.
• Pain in nose.
• Foul smelling or bloody discharge
• Bleeding from nose.

20. • A foreign body aspirated into the air passage can
lodge in the larynx, trachea or bronchi.
• Site of lodgement would depend on the size,
shape and nature of the foreign body.
• A large foreign body, unable to pass through the
glottis, will lodge in the supraglottic area while
the smaller ones will pass down through the
larynx into the trachea or bronchi.

21. LARYNGEAL SYMPTOMS
• Pain in throat
• Change of voice
• Cough
• Dyspnea
• Wheezing
• Hemoptysis
• Sudden death

22. TRACHEAL SYMPTOMS
• Cough
• Stridor
• Asthmatiod Wheeze
• Palpatory thud
• Audible slap

23. BRONCHIAL SYMPTOMS
Symptoms are divided into three stages:
• Initial period
• Symptomless period
• Later symptoms

24. BRONCHIAL SYMPTOMS
• Cough, wheeze and diminished air entry into
the lungs form a triad.
• Respiratory distress with the swelling of a
foreign body.
• Lung collapse, emphysema, pneumonitis,
bronchiectasis, or lung abscess are late
features.

26. ETIOLOGY OF FOREIGN BODY IN
FOOD PASSAGE
1. Age : Children are most often affected. Nearly
80% are below five years.
2. Loss of protective mechanism : use of upper
denture.
3. Carelessness : Poorly prepared food, improper
mastication, hasty eating and drinking.
4. Narrowing of esophageal lumen : In case of
esophageal stricture or carcinoma.

27. TYPES OF FOREIGN BODY IN FOOD
PASSAGE
• Sharp or blunt
• Radiopaque or radiolucent
• Metallic- coins, pins, denture wires, battery,
etc.
• Bones- fish, chicken, etc.
• Plastic- toys, beads, etc.

28. SITE OF LODGEMENT OF FOREIGN
BODY
1. Tonsil
2. Base of tongue or Vallecula
3. Posterior Pharyngeal Wall
4. Pyriform fossa
5. Oesophagus
• Most common site: at or below the
cricopharyngeal sphincter

29. SYMPTOMS OF FOREIGN BODY IN
FOOD PASSAGE
1. History of initial choking or gagging
2. Discomfort or pain located just above the
clavicle on the right or left of trachea
3. Dysphagia
4. Drooling of saliva
5. Respiratory distress
6. Substernal or epigastric pain

30. SIGNS OF FOREIGN BODY IN FOOD
PASSAGE
1. Tenderness in the lower part of neck on the
right or left of trachea
2. Pooling of secretions in the pyriform fossa on
indirect laryngoscopy. They do not disappear
on swallowing
3. Sometimes a foreign body may be seen
protuding from the esophageal opening in
the postcricoid region

31. DIAGNOSIS OF FOREIGN BODY
IN AIR PASSAGE
1. X-Ray neck and chest
• Posterio-anterior and lateral view
• For Radio-opaque foreign bodies
2. CT SCAN for radiolucent objects

32. X-RAY OF NASAL CAVITY

33. X-RAY OF THE LARYNX
( LATERAL VIEW)

35. X-RAY OF THE CHEST

36. DIAGNOSIS OF FOREIGN BODY IN
FOOD PASSAGE
1. X-Ray of the neck and chest
• AP and Lateral view
• For Radio-opaque foreign body
2.CT Scan for radiolucent foreign
body
3. Oesophagoscopy

37. X-RAY OF FOREIGN BODY IN FOOD
PASSAGE

38. FOREIGN BODIES IN DIGESTIVE
TRACT

39. Double lumen sign: DISC BATTERY

40. MANAGEMENT OF FOREIGN BODY

41. NOSE AND NASOPHARYNX
Animate Foreign Body
Patient to be isolated
Broad spectrum antibiotics
Analgesics
Good nourishment
Iron and Vitamin tablets
Inj. TT
 Removal of Maggots after CAT application
Maggots are removed by forceps/douching
Daily alkaline douching to remove sequestrum
Necrotic turbinates to remove endoscopically

42. INANIMATE FOREIGN BODY
•Detailed history
•Child Restrained
•Nasal Decongestants instilled
•Suctioning done to visualize the foreign body
•A curved hook or vectis can be used to remove
the FB
•Nasal cavities should be reexamined.

43. •INDICATIONS FOR GENERAL ANAESTHESIA
- Uncooperative patients
- Impacted Foreign Body
- Posteriorly placed Foreign Body
- Not visible in anterior rhinoscopy and
radiolucent
- Long standing Foreign Body

44. Rhinolith
•Removal of
impacted
rhinolith is done
under GA
•It is preferable
to break the
rhinolith

45. Button Battery
•It is a surgical
emergency and
needs to be
removed as soon
as possible.

46. LARYNX
• Laryngeal Foreign body
A large food bolus may partially obstruct the
air passage of the patient and cause dypsnoea
The patient in this case is to be treated by
giving steroids, bronchodilators and
humidified oxygen
Tracheostomy

47. • Heimlich manoeuvre. Stand behind the person
and place your arms around his lower chest and
give four abdominal thrusts. The residual air in
the lungs may dislodge the foreign body
providing some airway
• Cricothyrotomy or emergency tracheostomy
should be done if Heimlich manoeuvre fails.
Once acute respiratory emergency is over,
foreign body can be removed by direct
laryngoscopy or by laryngofissure, if impacted.

49. • Tracheal and bronchial foreign
bodies can be removed by
bronchoscopy with full
preparation and under general
anaesthesia.
Emergency removal of these
foreign bodies is not indicated
unless there is airway
obstruction or they are of the
vegetable nature (e.g. seeds)
and likely to swell up.
TRACHEA AND BRONCHUS

50. Methods to remove tracheobronchial foreign
body:
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.

51. 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.

53. Fig: A Dormia Basket
Fig: Flexible fibreoptic
Bronchoscope

54. • Equipment for foreign body removal include:
1. Bronchoscope, appropriate for the age of patient
and a size smaller and the other a size larger
2. Telescope or optical forceps.
3. Two laryngoscopes.
4. Foreign body forceps, Dormia basket, Fogarty’s
catheter and a syringe to inflate it.

55. OESOPHAGUS
1. Endoscopic Removal.
• Most of the foreign bodies
oesophagus can be
removed by
oesophagoscopy under
general anaesthesia.
• Both rigid and flexible
scopes can be used to
remove foreign bodies from
the oesophagus.

56. • A hypopharyngeal speculum resembling a
laryngoscope with long blade is less traumatic
and more convenient to use for foreign bodies
lodged near the upper sphincter.
• 2. Cervical Oesophagotomy. Impacted foreign
bodies or those with sharp hooks such as
partial dentures located above thoracic inlet
may require removal through an incision in
the neck and opening of cervical oesophagus.

57. • 3. Transthoracic Oesophagotomy. For
impacted foreign bodies of thoracic
oesophagus, chest is opened at the
appropriate level.
• A foreign body which has passed the pylorus
of stomach may pass through rest of
gastrointestinal tract without difficulty; stool
should be examined daily for 3–4 days for
spontaneous expulsion. Patient should take a
normal diet and no purgative should be
administrated to hasten the passage of foreign
body

58. FIGURE SHOWING CERVICAL OESOPHAGOTOMY

59. • Operative interference is required when
conservative treatment fails and in following
conditions:
(a) Patient complains of pain and tenderness
in abdomen.
(b) Foreign body is not showing any progress
on periodic X-rays taken at a few days
interval.

60. (c) Objects are sharp and likely to penetrate or
get obstructed, e.g. nails, pins, needles, sharp
bones, denture fragments, razors and long
thin wires.
(d) Foreign body is 5 cm or longer (e.g. hair
pin) in a child of 2 years; it is unlikely to pass
through turns of duodenum. A disc battery
larger than 1.5 cm in a child of 6 years and
remaining in stomach for 48 h.
(e) There is pyloric stenosis.

61. MANAGEMENT OPTIONS OF FB COIN
IN THORACIC ESOPHAGUS
1) Observation
2) Extraction by Foley catheter , guided or not
by fluroscopy
3) Rigid or flexible esophagoscopy
4) Extraction by Magill forceps
5) Push the coin to the stomach

62. THORACOTOMY IN REMOVAL OF
BRONCHIAL FOREIGN BODY
• INDICATIONS FOR THORACOTOMY
• If foreign body present at extremely
peripheral bronchus
• If foreign body lodged firmly in bronchus
surrounded by a granulation tissue
• If foreign body tightly wedged in the right or
left bronchus

63. MANAGEMENT OF FB COIN IN COLON
IF IT IS PRESENT IN THE LOWER
ABDOMEN
• Upto 90% of gastrointestinal foreign body pass
spontaneously through the digestive tract
without inflicting any harm on patients
• However if there is any inflammation of the
ileocaecal valve ( 2nd narrowest junction of GI
tract) then colonoscopic removal of such
foreign bodies is an effective and safe method

64. THANK YOU!