This document discusses foreign bodies in the air passages. It notes that foreign bodies can lodge in the larynx, trachea, or bronchi depending on their size and shape. Children commonly aspirate foreign bodies during play. Symptoms depend on the location of the foreign body and include cough, wheezing, difficulty breathing. Diagnosis involves history, x-rays, fluoroscopy, and endoscopy. Management involves removing laryngeal foreign bodies with maneuvers like Heimlich or surgery. Tracheal and bronchial foreign bodies require bronchoscopy for removal. Removal devices include forceps, baskets, and balloon catheters.

1. FOREIGN BODIES OF
AIR PASSAGES
•DR. AZAD MEENA
•JRA 1ST
•DR. T. KUMAR UNIT

3. • A FB aspirated air passage can lodge in the
larynx, trachea and bronchi.
• Site of the lodgement would depend on the size,
shape and nature of FB.
• A large FB will lodge in supraglottic area while
smaller one will pass down through the larynx
into the trachea or bronchi.
• Sharp FB (pins, fish bones, needle) can stick
anywhere in the larynx or tracheobronchial tree.

5. AETIOLOGY
• Children are more commonly affected, more
than half of them are below 4 years.
• Accidents occur when they suddenly inspire
during play and fight while having something
in the mouth.
• In adults, FB aspirated during coma, deep
sleep or alcoholic intoxication. Loose teeth
and denture may be aspirated during
anaesthesia.

6. Nature of FB
1) Nonirritating type. It May remain
symptomless for a long time. E.g. – plastic,
glass, metallic FB etc.
2) Irritating type. FB set up a diffuse violent
reaction leading to congestion and oedema
of tracheobronchial mucosa. Eg- peanut,
beans, seeds etc. Vagetative FB swell up with
time causing airway obstruction and latter
suppuration in lung.

8. Clinical feature
• Devided into three stages.
1). Initial period of choking, gagging and wheezing-
this lasts for a short time. FB may be coughed out
or it may lodge in the larynx or further down in
the tracheobronchial tree.
2). Symptomless interval- the respiratory mucosa
adapts the presence of FB. Symptomless interval
will vary with the size and nature of foreign body.
It may last a few hours to few weeks

9. 3). Later symptoms – they are caused by airway
obstruction, inflamation or trouma induced by
FB and would depend on the site of
lodgement.
Laryngeal FB
Tracheal FB
Bronchial FB

10. 1) LARYNGEAL FB
• A large FB may totally obstruct the airway
leading to sudden death unless resuscitative
measures taken urgently.
• A partially obstructive FB will cause-
discofort or pain in throat
hoarseness
croupy cough
dyspnoea
wheezing and haemoptysis

11. 2) TRACHEAL FB
• Sharp FB will only produces cough and
haemoptysis.
• A loose FB may move up and down the
trachea b/w the carina and undersurface of
vocal cord causing “audible slap” and
“palpatory thud”
• Asthmatoid wheeze may also be present. It is
best heared at patient’s open mouth.

12. 3) BRONCHIAL FB
• Most FB enter in right bronchus because it is wider
and and more in line with tracheal line.
• A FB may totally obstruct a lobar or segmental
bronchus causing atelectasis.
• It may produce a check valve obstruction, allowing
only ingress of air but not the egress thus leading
to obstructive emphysema.
• Emphysematous bulla may rupture causing
spontaneous pneumothorax.

14. • A FB may also shift one side to onother side
causing change in physical sign
• A retained FB in the lung may later give rise to
pneumonitis, bronchiectsis or lung abcess.

15. DIAGNOSIS
1). It can be made by detailed history of FB.
• A histroy of classical triad of
a). Sudden onset of coughing
b). Wheezing
c). Diminished air entry in lungs on palpation

16. 2). Soft tissue PA & Lateral view of neck
with extended position.
• This can be radio-opaque and someties
radiolucent.
• A coin FB of larynx seen flat on lateral
view and edge on PA view
• Emphysema, segmental or lobar
atelectasis may seen.

17. FB (coin) larynx

18. FB (coin) Esophagus

19. 3). Fluroscopy/videofluroscopy-
• It is a dynamic method of evaluation. It is
more sensitive than X-Ray.
• It is more useful when radiolucent FB
suspected and X-Ray inconclusive.
• Fluroscopy show phasic mediastinum shift
• Mediastinum shift during inspiration indicate
side of FB.

20. 4) CT SCAN chest showing fb

21. 5).ENDOSCOPIC DIAGNOSIS

22. MANAGEMENT
• Devided into two part
1) Laryngeal FB treatment
2) Tracheal and bronchial FB treatment

23. LARYNGEAL FB MAMAGEMENT
• HEIMLICH MANOEUVRE –
• it is indicated when total obstruction of airway.
• In this manoeuvre stant behind the patient and
place your arm around his lower chest and give
four abdominal thrusts. Residual air in lungs may
dislodge the FB and provide some airway in
emergency
• C/I in partial airway obstruction due to fear of total
obstruction

25. If heimlich manoeuvre fail
• Cricothyrotomy or emergency tracheostmy
should be done.
• Once acute respiratory emergency is over, FB
can be removed by direct laryngoscopy

26. TRACHEAL OR BRONCHIAL FB REMOVAL
• Can be removed by bronchoscopy with full
preparation under GA.
• Emergency removal of these FB is not indicated
unless there is airway obstruction or vagetable
nature FB and likely to swell up.

27. Methods to remove tracheobronchial FB
1) Convevtional rigid bronchoscopy
2) Rigid bronchoscopy with telescopic aid
3) Use of Dormia basket or Fogarty’s balloon for
rounded objects.
4) Tracheostomy first and then bronchoscopy
through tracheostome
5) Thracotomy and bronchotomy for peripheral FB
6) flexible fibreoptic bronchoscopy in adult

28. • Equipment for FB removal include.
1) Bronchoscope appropriate for age of patient
2) Telescope or optic forceps
3) Laryngoscope
4) FB remaval forceps,Dormia basket, Fogarty’s
catheter and a syringe to inflate it.

29. BRONCHOSCOPE

30. Dormia basket –
used for round FB.

31. Fogarty’s catheter
• Used to place behind
the FB then inflate it so
FB will not push down
again.
• a hollow tube present in
it which prevents to
lung collapse.

32. • Thank you