This presentation is orginaly uploaded to http://kpkmedicalcolleges.tk by Dr.Suleman

1. Anatomy of the TracheoBronchial Tree
The trachea commences in the neck below the cricoid cartilage
at the level of lower border of C6 vertebra. Entering in the
thoracic inlet in the midline, the trachea lies in contact with the
manubrium and is normally said to bifurcate at its lower border.
Its total lenth is about 15 cm. Its wall is fibroelastic membrane
whose patency is maintained by C-shaped rings of Hyaline
cartilage. The gaps lie posteriorly and are closed by a sheet of
unstripped muscle(trachealis muscle) whose contractions
diminishes the calibre of tube.

2. The Bronchi are symmetrical, the right being one third
wider and a little shorter then left. At the bifurcation
an anteroposterior ridge the carina, lies to the left of
the midline. The right bronchus slopes more
steeply(25 degrees off vertical) then the left(45
degrees off the vertical), so that the foreign bodies of
whatever shape are statistically more likely to enter
the right bronchus. In the structure the bronchi are
identical with the trachea.

4. Foreign bodies in the larynx and trachea
The maximum incidence in the inhalation of the foreign
bodies occurs between the age of one and three years. The
most common cause of accidental death in the home in
children under 06 years of age , is the inhalation of foreign
bodies.

6. The peak incidence of inhalation of foreign bodies
in early childhood is of course related to the fact that
children have the habbit of putting objects into their
mouths to determine their texture and taste and to
chew on when teething. It is extremely important,
therefore when possible to keep objects which might
be inhaled out of the reach of small children.

7. Types of foreign bodies inhaled
1)
2)
3)
4)
5)
6)
7)
8)
9)
10)
11)
12)
13)
14)
15)
16)
Portion of Nut.
Whole Nut(peanut, bean, channa, cashio, pistachio).
Food.
Carrots.
Popcorn.
Fruit(stem,seed,peel).
Bone.
Plastic(whistle).
Metal.
Tooth.
Stone.
Bead.
Balloon.
Crayon.
Wood.
Paper.

8. History
In most cases of inhaled foreign body, there is a definite history of
chocking followed by paroxysmal coughing which then subsides.
After the initial paroxysm of coughing the tracheobroncheal mucosa
becomes tolerant of the foreign body and coughing ceases. This
feature is often responsible for delays in diagnosis.other symptomps
are
-history of wheeze.
-Unexplained persistent fever.
- unsuspected foreign body at routine Endoscopy for other reasons.
-Acute respiratory distress.
-Pain at the root of neck.
-Sharp and long standing oesophageal foreign bodies may produce a
fistula between the oesophagus and the trachea and cause

9. Clinical examination of foreign bodies of Larynx and
Trachea.
-General examination of child is essential, Respiratory distress or cyanosis
demands immediate action.
-If there is a change in child’s cry or if the cry becomes hoarse or stridulous, a
laryngeal foreign body should be suspected.
-Excessive salivation may also occur.
-An audible click may be heard due to movement of foreign body up and down
the trachea.
-A fluttering noise may also be heard.
-A unilateral expiratory wheeze and reduced air entry may indicate foreign body
in the bronchus.
-If foreign body is not removed within 24 hours, pneumonic signs occurs.
-Dry vegetable foreign bodies e.g: bean cause very rapid obstructive changes.
-Atelectasis of occluded segment of the lung occurs.
-The presence of florid granulation tissue around the inhaled foreign body may
also cause haemoptysis.

10. Radiological findings.
X-ray neck should be taken with the neck extended with
anteroposterior and lateral views. Anteroposterior view
of the chest in inspiration and expiration should be
obtained. Obstructive emphysema is produced by a
valvular obstruction to the expiratory air stream due the
presence of the foreign body in the lumen of air
passage.

15. Management of foreign bodies of Larynx and
Trachea.
If foreign body in the respiratory tract is suspected or
diagnosed radiologically, endoscopic examination and
removal under general anesthesia is the method of choice.
In case of Laryngeal or large tracheal foreign bodies, this
should be performed as an emergency procedure.
If the airway is compromised, the endoscopy must be
performed immediately with the facilities for performing
an emergency tracheostomy. Large tracheal foreign bodies
may have to be delivered through a tracheostomy.

16. Laryngeal foreign bodies are removed by direct
laryngoscopy.
Tracheal and Bronchial foreign bodies are best
removed using a rigid bronchoscope.
In the absence of respiratory distress the operation
should be performed as an elective procedure by the
Surgical team that are used to working together in their
accustomed operating theatre.

17. In the rare event if surgeon is unable to remove a
foreign body endoscopically, inspite of satisfactory
operating conditions, it must be removed by
thoracotomy and bronchotomy.