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Vincent M, Vergnon JM. [Foreign body of dental origin: How to retrieve the dentist's drill?]. Rev Mal Respir 2015; 33:63-6. [PMID: 26232208 DOI: 10.1016/j.rmr.2015.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 02/13/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Inhalation of foreign bodies is an unusual complication of dental care. When it occurs immediately during the intervention, it is generally a dental tool, such as the little screwdrivers used for dental implant procedures. CASE REPORT A 59-year-old man was referred to our hospital for asymptomatic inhalation of a small drill during dental surgery. Because the drill had a barbed tip, prompt removal was indicated. The foreign body was localized in a sub-segmental division of the left lower lobe (B10b) and could be removed via a flexible bronchoscope under a short general anesthetic without intubation. There was no significant injury of the bronchial mucosa. CONCLUSION Inhalation of foreign bodies during dental interventions is unusual and sometimes asymptomatic but their removal is always indicated. In some cases, the removal can be performed with a flexible bronchoscope.
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Affiliation(s)
- M Vincent
- Service de pneumologie et oncologie thoracique, hôpital Nord, CHU de Saint-Étienne, 42000 Saint-Étienne, France
| | - J-M Vergnon
- Service de pneumologie et oncologie thoracique, hôpital Nord, CHU de Saint-Étienne, 42000 Saint-Étienne, France.
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Kechna H, Ouzzad O, Aissaoui Y, Nadour K, Zaini R. [Extracting a tracheobronchial bronchial foreign body with a uretheroscope]. Pan Afr Med J 2015; 20:74. [PMID: 26090032 PMCID: PMC4450043 DOI: 10.11604/pamj.2015.20.74.6002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 01/24/2015] [Indexed: 11/11/2022] Open
Affiliation(s)
- Hicham Kechna
- Service Anesthésie Réanimation, Hôpital Militaire, Guelmim, Maroc
| | - Omar Ouzzad
- Service Anesthésie Réanimation, Hôpital Militaire, Guelmim, Maroc
| | - Youness Aissaoui
- Service Anesthésie Réanimation, Hôpital Militaire, Guelmim, Maroc
| | - Karim Nadour
- Service oto-rhino-laryngologie, Hôpital Militaire, Guelmim, Maroc
| | - Rachid Zaini
- Service Urologie, Hôpital Militaire, Guelmim, Maroc
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Fang YF, Hsieh MH, Chung FT, Huang YK, Chen GY, Lin SM, Lin HC, Wang CH, Kuo HP. Flexible bronchoscopy with multiple modalities for foreign body removal in adults. PLoS One 2015; 10:e0118993. [PMID: 25768933 PMCID: PMC4358882 DOI: 10.1371/journal.pone.0118993] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 01/08/2015] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES Aspiration of the lower airways due to foreign body is rare in adults. This study aimed to determine the outcome of patients who received flexible bronchoscopy with different modalities for foreign body removal in the lower airways. PATIENTS AND METHODS Between January 2003 and January 2014, 94 patients diagnosed with foreign body in the lower airways underwent flexible bronchoscopy with different modalities, which included forceps, loop, basket, knife, electromagnet, and cryotherapy. The clinical presentation, foreign body location and characteristics, and applications of flexible bronchoscopy were analyzed. RESULTS Forty (43%) patients had acute aspiration, which developed within one week of foreign body entry and 54 (57%) had chronic aspiration. The most common foreign bodies were teeth or bone. More patients with chronic aspiration than those with acute aspiration were referred from the out-patient clinic (48% vs. 28%), but more patients with acute aspiration were referred from the emergency room (35% vs. 6%) and intensive care unit (18% vs. 2%). Flexible bronchoscopy with different modalities was used to remove the foreign bodies (85/94, 90%). Electromagnet or cryotherapy was used in nine patients to eliminate the surrounding granulation tissue before foreign body removal. In the nine patients with failed flexible bronchoscopy, eight underwent rigid bronchoscopy instead and one had right lower lung lobectomy for lung abscess. CONCLUSIONS Flexible bronchoscopy with multiple modalities is effective for diagnosing and removing foreign bodies in the lower respiratory airways in adults, with a high success rate (90%) and no difference between acute and chronic aspirations.
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Affiliation(s)
- Yueh-Fu Fang
- Department of Thoracic Medicine, Chang Gung Foundation, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Meng-Heng Hsieh
- Department of Thoracic Medicine, Chang Gung Foundation, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Fu-Tsai Chung
- Department of Thoracic Medicine, Chang Gung Foundation, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yao-Kuang Huang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Chia-Yi, Taiwan
| | - Guan-Yuan Chen
- Department of Thoracic Medicine, Chang Gung Foundation, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shu-Min Lin
- Department of Thoracic Medicine, Chang Gung Foundation, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Horng-Chyuan Lin
- Department of Thoracic Medicine, Chang Gung Foundation, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chin-Hwa Wang
- Department of Thoracic Medicine, Chang Gung Foundation, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Han-Pin Kuo
- Department of Thoracic Medicine, Chang Gung Foundation, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- * E-mail:
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Growing Antibiotic Resistance in Fatal Cases of Staphylococcal Pneumonia in the Elderly. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 905:39-56. [DOI: 10.1007/5584_2015_184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Aggarwal SK, Sinha SK, Ratan SK, Dhua A, Sethi GR. Complications of Long-Standing Foreign Body in the Airway and Their Outcomes After Endoscopic Management: An Experience of 20 Cases. J Laparoendosc Adv Surg Tech A 2015; 25:81-7. [DOI: 10.1089/lap.2014.0354] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Satish Kumar Aggarwal
- Department of Pediatric Surgery, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Shandip Kumar Sinha
- Department of Pediatric Surgery, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Simmi K. Ratan
- Department of Pediatric Surgery, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Anjan Dhua
- Department of Pediatric Surgery, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Gulshan Rai Sethi
- Department of Paediatrics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
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57
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Kaddah S, Ahmed S. Management of airway foreign body using flexible bronchoscopy: Experience with 80 cases during 2011–2013. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2015. [DOI: 10.1016/j.ejcdt.2014.11.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Kim IA, Shapiro N, Bhattacharyya N. The national cost burden of bronchial foreign body aspiration in children. Laryngoscope 2014; 125:1221-4. [DOI: 10.1002/lary.25002] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Irene A. Kim
- Otolaryngology-Head & Neck Surgery; David Geffen School of Medicine at UCLA; Los Angeles California
| | - Nina Shapiro
- Otolaryngology-Head & Neck Surgery; David Geffen School of Medicine at UCLA; Los Angeles California
| | - Neil Bhattacharyya
- Department of Otology & Laryngology; Harvard Medical School; Boston Massachusetts U.S.A
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Abstract
Choking is a preventable, but common cause of morbidity and mortality in the pediatric population, with children younger than 3 years at greatest risk. A number of factors place children at higher risk for choking, including narrower airways, immature dentition, underdeveloped chewing and swallowing ability, and high levels of activity and distractibility. Candy, meat, and bone are responsible for more than half of nonfatal food-related choking, while the hot dog is the most common food associated with choking fatalities. Coins, button batteries, small toys, and toy parts are the leading causes of nonfatal choking not due to food, while latex balloons are the leading cause of nonfood-related choking fatalities. Pediatric choking is an important public health concern that needs to be addressed during well-child visits and through increased public education. Parents and child caregivers should receive training in cardiopulmonary resuscitation and choking rescue maneuvers. Increased efforts are also needed in the areas of public policy, choking surveillance, and food design and labeling.
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Affiliation(s)
- Sarah A. Denny
- Section of Emergency Medicine, Nationwide Children’s Hospital, Columbus, Ohio (SAD, GAS)
- Center for Injury Research and Policy, Nationwide Children’s Hospital, Columbus, Ohio (SAD, NLH, GAS)
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio (SAD, GAS)
| | - Nichole L. Hodges
- Section of Emergency Medicine, Nationwide Children’s Hospital, Columbus, Ohio (SAD, GAS)
- Center for Injury Research and Policy, Nationwide Children’s Hospital, Columbus, Ohio (SAD, NLH, GAS)
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio (SAD, GAS)
| | - Gary A. Smith
- Section of Emergency Medicine, Nationwide Children’s Hospital, Columbus, Ohio (SAD, GAS)
- Center for Injury Research and Policy, Nationwide Children’s Hospital, Columbus, Ohio (SAD, NLH, GAS)
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio (SAD, GAS)
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60
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Tracheobronchial foreign body aspiration: dental prosthesis. Case Rep Pulmonol 2014; 2014:465856. [PMID: 25165606 PMCID: PMC4137749 DOI: 10.1155/2014/465856] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 07/15/2014] [Accepted: 07/15/2014] [Indexed: 11/17/2022] Open
Abstract
It is important to extract foreign bodies for avoiding life-threatening complications. They can lead to death if they are not treated. Different signs and symptoms could occur according to the complete or partial airway obstruction. Foreign body aspiration is a rare incident in adults. The organic foreign materials such as foods are found to be aspirated more commonly and are usually settled in the right bronchial system. However, dental prosthesis and teeth aspirations are rare in literature. In our study, a 52-year-old male patient who had aspirated the front part of his lower dental prosthesis accidentally is presented and the foreign body is extracted by using rigid bronchoscopy. There are many causes of aspiration but dental prosthetic aspirations should be kept in mind during sleep. For this reason, dental apparatus must be taken out while asleep.
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61
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Ling Hsu AA, Pena Takano AM, Wai Chan AK. Beyond removal of endobronchial foreign body. Am J Respir Crit Care Med 2014; 189:996-7. [PMID: 24735034 DOI: 10.1164/rccm.201311-2039im] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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62
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Madkour A, Elmansoury A, Sharkawy S. The efficacy of fiberoptic bronchoscopy through laryngeal mask airway in pediatric foreign body extraction. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2014. [DOI: 10.4103/1687-8426.137354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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63
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Endoscopic removal of an aspirated healing abutment and screwdriver under conscious sedation. IMPLANT DENT 2014; 23:250-2. [PMID: 24819812 DOI: 10.1097/id.0000000000000100] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Aspiration of foreign bodies during dental treatment is a medical emergency that requires prompt removal. In this study, aspiration of screwdriver and healing abutment is reported with literature review. MATERIALS AND METHODS A 26-year-old male patient was referred from a local dental clinic with the suspicion of ingestion of a screwdriver and healing abutment during the second-stage surgery. The patient reported symptoms including dyspnea, cough, and foreign body sensation. On the chest radiograph, a radiopaque foreign body resembling the screwdriver and healing abutment was observed at the right mid lung. RESULTS Bronchoscopic examination using flexible cable was performed under conscious sedation, and microforceps were used to remove the instruments. Aspirated screwdriver and healing abutment were removed safely under intravenous sedation. The patient did not have any symptoms associated with lung aspiration after removal of the foreign body during follow-up periods. CONCLUSION Bronchoscopic removal is the most recommended procedure for removal of the aspirated foreign body. This can be performed under conscious sedation. Precautions, such as tethering the screwdriver, are recommended during implant procedures.
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64
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Affiliation(s)
- Harpal Singh
- 1Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India
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65
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Komiya K, Ishii H, Kadota JI. Healthcare-associated Pneumonia and Aspiration Pneumonia. Aging Dis 2014; 6:27-37. [PMID: 25657850 DOI: 10.14336/ad.2014.0127] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 01/24/2014] [Accepted: 01/27/2014] [Indexed: 12/13/2022] Open
Abstract
Healthcare-associated pneumonia (HCAP) is a new concept of pneumonia proposed by the American Thoracic Society/Infectious Diseases Society of America in 2005. This category is located between community-acquired pneumonia and hospital-acquired pneumonia with respect to the characteristics of the causative pathogens and mortality, and primarily targets elderly patients in healthcare facilities. Aspiration among such patients is recognized to be a primary mechanism for the development of pneumonia, particularly since the HCAP guidelines were published. However, it is difficult to manage patients with aspiration pneumonia because the definition of the condition is unclear, and the treatment is associated with ethical aspects. This review focused on the definition, prevalence and role of aspiration pneumonia as a prognostic factor in published studies of HCAP and attempted to identify problems associated with the concept of aspiration pneumonia.
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Affiliation(s)
- Kosaku Komiya
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Yufu, Japan ; Clinical Research Center of Respiratory Medicine, Tenshindo Hetsugi Hospital, Oita, Japan
| | - Hiroshi Ishii
- Department of Respiratory Medicine, Fukuoka University Hospital, Jonan-ku, Fukuoka, Japan
| | - Jun-Ichi Kadota
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Yufu, Japan
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66
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Lammy S, Pringle E, Carnochan F, Rodgers H, Yan T, Walker W. Right lower lobectomy following inhalation of a toy traffic cone. JRSM SHORT REPORTS 2013; 4:2042533313476699. [PMID: 24319576 PMCID: PMC3831860 DOI: 10.1177/2042533313476699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Simon Lammy
- Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK ; The Collaborative Research (CORE) Group, Sydney, Australia
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Falase B, Sanusi M, Majekodunmi A, Ajose I, Oke D. Preliminary experience in the management of tracheobronchial foreign bodies in Lagos, Nigeria. Pan Afr Med J 2013; 15:31. [PMID: 24009807 PMCID: PMC3758847 DOI: 10.11604/pamj.2013.15.31.2710] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 05/05/2013] [Indexed: 11/27/2022] Open
Abstract
Aspiration of tracheobronchial foreign bodies commonly affects young children, is potentially life threatening and requires early intervention for extraction. Access to facilities and skill manpower for bronchoscopic extraction is however limited in Nigeria. The aim of this study is to describe the experience in our institution with bronchoscopic removal of tracheobronchial foreign bodies and highlight the challenges encountered. This is a retrospective study of all patients referred to the Lagos State University Teaching Hospital with a diagnosis of tracheobronchial foreign body within the period of February 2008 and February 2013. Data extracted from the medical records were age, sex, time interval between aspiration and presentation, location of tracheobronchial foreign body, bronchoscopic technique, complications and outcome. A total of 24 patients were referred and confirmed at bronchoscopy to have tracheobronchial foreign bodies. Mean age was 6.6 + 5 years. Male to female ratio was 1:1. Delayed presentation was common with 22 patients (91.7%) presenting more than 24 hours after aspiration. Aspirated material was inorganic in 17 patients (70.8%) and organic in 7 patients (29.2%). Location of tracheobronchial foreign bodies was right main bronchus in 16 patients (66.7%), left main bronchus in 6 patients (25%) and the trachea in 2 patients (8.3%). Challenges to speedy and safe removal of the foreign bodies were delayed presentation and a limited range of bronchoscopic equipment early in the series which caused prolonged procedures and increased complications. Two mortalities occurred early in the series; one from airway obstruction and the other from respiratory failure caused by tracheobronchial oedema. Extraction of tracheobronchial foreign bodies was faster, more complete and safer later in the series due to a wider range of bronchoscopy equipment which included both flexible and rigid videobronchoscopy with the use of optical forceps. This preliminary experience suggests that an adequate armamentarium of bronchoscopy equipment is required to increase the chances of complete extraction, speed up the procedure and reduce the risk of complications of Tracheobronchial Foreign Bodies in our environment. Delayed presentation increases the difficulty of the procedure so earlier referral of these patients would help reduce the risk involved in their management.
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Affiliation(s)
- Bode Falase
- Cardiothoracic Division, Department of Surgery, Lagos State University College of Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
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69
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70
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Abstract
Coughing, wheezing, dyspnea and recurrent pneumonia can be signs of foreign body aspiration. About 80% of all foreign body aspirations occur in children, especially in infants between 1 and 3 years of age. Although most foreign bodies are found in the bronchi they are especially dangerous in the larynx or trachea. Foreign body aspiration is less common in adults, being confirmed in only about 1-2 of every 1,000 bronchoscopies. The most common foreign bodies are foods particles. Bronchoscopy is the method of choice for foreign body removal.
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Affiliation(s)
- F J F Herth
- Pneumologie und Beatmungsmedizin, Thoraxklinik, Universitätsklinikum Heidelberg, Deutschland.
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71
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Hada MS, Chadda V, Mishra P, Gupta P, Grover M. Unusual metallic foreign bodies in the larynx: two case reports. Indian J Pediatr 2012; 79:1100-2. [PMID: 22237635 DOI: 10.1007/s12098-011-0621-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Accepted: 11/24/2011] [Indexed: 10/14/2022]
Abstract
Impaction of a foreign body (FB) in the larynx is a rare situation. It is more common in children then older age group. The authors report two cases of unusual foreign bodies in the larynx which presented with complaints of sudden onset of change of voice without any respiratory difficulty. One was of 9 y and other was a 7-y-old boy with foreign body in the glottis. In both cases there was accidental inhalation of the FB which was immediately followed by difficulty of speech. Metallic foreign bodies were removed successfully by direct laryngoscopy under general anesthesia (GA) which is followed by recovery of the symptoms.
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72
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El Koraïchi A, Mokhtari M, El Haddoury M, El Kettani SE. [Rigid bronchoscopy for pin extraction in children at the Children's Hospital in Rabat, Morocco]. REVUE DE PNEUMOLOGIE CLINIQUE 2011; 67:309-313. [PMID: 22017951 DOI: 10.1016/j.pneumo.2010.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2010] [Revised: 10/28/2010] [Accepted: 11/03/2010] [Indexed: 05/31/2023]
Abstract
PURPOSE The aim of this work is to present the clinical and therapeutic aspects of pin inhalation in the airways, as well as the benefit of rigid bronchoscopy for extraction in children. MATERIALS AND METHODS Five hundred and twenty-four cases of inhaled foreign body are identified in the multipurpose pediatric intensive care unit in the children's hospital in Rabat between January 2005 and December 2010. Thirty-six (6.8%) of them are due to pin inhalation. A retrospective study was conducted to define the epidemiological characteristics, clinical treatment and outcome of pin inhalation in the airways. RESULTS Thirty-six cases of pin inhalation are identified, all females. The age varies from 10 to 15 years. The consultation period is 2 days. Symptoms are dominated by coughing and stinging sensation. In 61.11% (22 cases), the pin is lodged in the right airways, in 22.22% (eight cases) in the left airways and in 5.5% (two cases) at the trachea. In 63.8% (23 cases), the pin is removed at the first attempt. We did not record any severe complications. No deaths recorded. CONCLUSION Pin inhalation is a common occurrence in young girls. The extraction can be done safely by rigid bronchoscopy under general anesthesia. Particular attention should be paid to prevention and educational programs to reduce the incidence of pin inhalation.
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Affiliation(s)
- A El Koraïchi
- Service de réanimation pédiatrique polyvalente, hôpital d'enfants de Rabat, BP 5071, Rabat, Morocco.
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Rizk H, Rassi S. Foreign body inhalation in the pediatric population: lessons learned from 106 cases. Eur Ann Otorhinolaryngol Head Neck Dis 2011; 128:169-74. [PMID: 21474416 DOI: 10.1016/j.anorl.2011.01.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Revised: 12/27/2010] [Accepted: 01/05/2011] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To review the cases encountered in a tertiary care center so as to assess the incidence of foreign body aspiration in the pediatric population and to draw on our experience to improve prevention and early diagnosis. PATIENTS AND METHODS Retrospective study of 106 children under the age of 15 years, admitted to the Hôtel-Dieu de France hospital for flexible and/or rigid bronchoscopy between November 1998 and January 2010, for suspected foreign body aspiration (FBA). RESULTS Among the children, 56.6% were aged between one and three years. Peanuts or pistachios were found in 48% of cases. In 73% of cases, the FB was bronchial, and slightly more frequently on the right side (60%); 17.8% of cases presented in emergency immediately after inhalation; 12% presented with life-threatening symptoms; 29% presented within 24 hours and 49% were seen later than 72 hours. In 81% of subjects, a typical penetration syndrome was found on interviewing the parents. Physical pulmonary examination was normal in 21% of patients and chest X-ray in 21.8%. Rigid bronchoscopy was preceded by flexible bronchoscopy in 12% of cases. Parental underestimation of the gravity of the situation was a significant factor in delayed diagnosis. Among the patients, 64% examined 24 hours after inhalation were initially treated for another pathology. Delay in diagnosis and organic vs inorganic FB did not significantly correlate with duration of bronchoscopy. The rate of complications did not significantly increase after a 24-hour diagnostic delay threshold. CONCLUSION FB aspiration is a serious problem. A high index of suspicion is required in health care providers (ENT, pediatricians and family physicians). Physician and especially parental education are the main guarantors of significantly reduced morbidity and mortality in this pathology.
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Affiliation(s)
- H Rizk
- Département d'Otorhinolaryngologie, Hôtel-Dieu de France, rue Alfred-Naccache, Beirut, Lebanon.
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Casap N, Alterman M, Lieberman S, Zeltser R. Enigma of missing teeth in maxillofacial trauma. J Oral Maxillofac Surg 2011; 69:1421-9. [PMID: 21216067 DOI: 10.1016/j.joms.2010.05.076] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2009] [Revised: 03/20/2010] [Accepted: 05/20/2010] [Indexed: 11/28/2022]
Abstract
PURPOSE The initial evaluation and treatment of trauma victims should follow a planned approach, as delineated by the Advanced Trauma Life Support protocol, with the main concern securing a patent airway. When trauma has been associated with maxillofacial injury, it can complicate airway management owing to aspirated avulsed teeth or dental prosthetic devices. In such cases, endotracheal intubation can be life-threatening, if the foreign bodies are pushed into the upper respiratory tract. The objective of the present report was to illustrate the diagnostic and management problems related to foreign bodies from the oral cavity lodged in the upper airway after blunt maxillofacial trauma or emergency endotracheal intubation. We also discussed how this could be prevented. PATIENTS AND METHODS A retrospective study was performed at the Department of Oral and Maxillofacial Surgery, Hadassah Medical Center (Jerusalem, Israel). The records of 1,411 patients admitted for treatment of facial trauma during the past 10 years were reviewed. RESULTS Of the 1,411 patients, 7 (0.5%) had aspirated foreign bodies that had lodged in the airway because of the trauma or subsequent intubation. CONCLUSIONS The patient's oral cavity and upper airway must be inspected thoroughly before attempting endotracheal intubation. Any foreign body should be removed from the mouth and throat. This process must be undertaken, despite the stressful and limiting conditions of emergency care.
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Affiliation(s)
- Nardy Casap
- Department of Oral and Maxillofacial Surgery, Hebrew University, Hadassah University Medical Center, Jerusalem, Israel.
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Fidkowski CW, Zheng H, Firth PG. The anesthetic considerations of tracheobronchial foreign bodies in children: a literature review of 12,979 cases. Anesth Analg 2010; 111:1016-25. [PMID: 20802055 DOI: 10.1213/ane.0b013e3181ef3e9c] [Citation(s) in RCA: 153] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Asphyxiation by an inhaled foreign body is a leading cause of accidental death among children younger than 4 years. We analyzed the recent epidemiology of foreign body aspiration and reviewed the current trends in diagnosis and management. In this article, we discuss anesthetic management of bronchoscopy to remove objects. The reviewed articles total 12,979 pediatric bronchoscopies. Most aspirated foreign bodies are organic materials (81%, confidence interval [CI] = 77%-86%), nuts and seeds being the most common. The majority of foreign bodies (88%, CI = 85%-91%) lodge in the bronchial tree, with the remainder catching in the larynx or trachea. The incidence of right-sided foreign bodies (52%, CI = 48%-55%) is higher than that of left-sided foreign bodies (33%, CI = 30%-37%). A small number of objects fragment and lodge in different parts of the airways. Only 11% (CI = 8%-16%) of the foreign bodies were radio-opaque on radiograph, with chest radiographs being normal in 17% of children (CI = 13%-22%). Although rigid bronchoscopy is the traditional diagnostic "gold standard," the use of computerized tomography, virtual bronchoscopy, and flexible bronchoscopy is increasing. Reported mortality during bronchoscopy is 0.42%. Although asphyxia at presentation or initial emergency bronchoscopy causes some deaths, hypoxic cardiac arrest during retrieval of the object, bronchial rupture, and unspecified intraoperative complications in previously stable patients constitute the majority of in-hospital fatalities. Major complications include severe laryngeal edema or bronchospasm requiring tracheotomy or reintubation, pneumothorax, pneumomediastinum, cardiac arrest, tracheal or bronchial laceration, and hypoxic brain damage (0.96%). Aspiration of gastric contents is not reported. Preoperative assessment should determine where the aspirated foreign body has lodged, what was aspirated, and when the aspiration occurred ("what, where, when"). The choices of inhaled or IV induction, spontaneous or controlled ventilation, and inhaled or IV maintenance may be individualized to the circumstances. Although several anesthetic techniques are effective for managing children with foreign body aspiration, there is no consensus from the literature as to which technique is optimal. An induction that maintains spontaneous ventilation is commonly practiced to minimize the risk of converting a partial proximal obstruction to a complete obstruction. Controlled ventilation combined with IV drugs and paralysis allows for suitable rigid bronchoscopy conditions and a consistent level of anesthesia. Close communication between the anesthesiologist, bronchoscopist, and assistants is essential.
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Affiliation(s)
- Christina W Fidkowski
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
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76
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NGUYEN LH, NGUYEN DH, TRAN TN, NGUYEN PT, THI QH, AELONY Y, HOMASSON JPD. Endobronchial foreign bodies in Vietnamese adults are related to eating habits. Respirology 2010; 15:491-4. [DOI: 10.1111/j.1440-1843.2010.01707.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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77
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Pingarrón Martín L, Morán Soto MJ, Sánchez Burgos R, Burgueño García M. Bronchial impaction of an implant screwdriver after accidental aspiration: report of a case and revision of the literature. Oral Maxillofac Surg 2010; 14:43-47. [PMID: 19834750 DOI: 10.1007/s10006-009-0178-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Adverse outcomes resulting from aspiration or ingestion of instruments and materials can occur in any dental procedure. Clinical manifestation depends on the location, the obstructive potential of the foreign body, and the temporal factor since the accidental incident. Accidental inhalation of dental appliances can be an even more serious event than ingestion and must always be treated as an emergency situation. CASE REPORT A 62-year-old woman was admitted to our hospital with the suspicion of ingestion of a screwdriver implants. In spite of the clinically asymptomatic presentation, chest radiography in posteroanterior and lateral projections showed a radiopaque dental instrument impacted on the right main inferior bronchus. Rigid bronchoscope was successful to remove the dental instrument under general anesthesia, and the patient was discharged 24 h later. CONCLUSION Aspiration and ingestion of dental foreign objects are infrequent, but they can occur at large multidisciplinary dental procedures. These episodes have the potential to result in acute medical and life-threatening emergencies since the beginning of the event or at a late stage in proceeding in the underdiagnosed patient. Prevention of such incidents is, therefore, the best approach via the mandatory use of precautions during all dental procedures, and in case of suspicion with no retrievable material, patient must always be submitted to a radiographic study.
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78
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Bronchoscopic Foreign Body Extraction in a Pulmonary Medicine Department. J Bronchology Interv Pulmonol 2010; 17:39-44. [DOI: 10.1097/lbr.0b013e3181cd5ca2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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79
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Saki N, Nikakhlagh S, Rahim F, Abshirini H. Foreign body aspirations in infancy: a 20-year experience. Int J Med Sci 2009; 6:322-8. [PMID: 19851473 PMCID: PMC2764343 DOI: 10.7150/ijms.6.322] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2009] [Accepted: 09/29/2009] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Foreign body aspirations comprise the majority of accidental deaths in childhood. Diagnostic delay may cause an increase in mortality and morbidity in cases without acute respiratory failure. We report our diagnostic and compare the relevant studies available in literature to our results. METHODS In our Hospital, bronchoscopy was performed on 1015 patients with the diagnosis of foreign body aspirations (from 1998 to 2008). Of these cases, 63.5% were male and 36.5% female. Their ages ranged from 2 months to 9 years (mean 2.3 years). Diagnosis was made on history, physical examination, radiological methods and bronchoscopy. RESULTS Foreign bodies were localized in the right main bronchus in 560 (55.1%) patients followed by left main bronchus in 191 (18.8%), trachea in 173 (17.1%), vocal cord in 75 (7.4%) and both bronchus in 16 (1.6%). Foreign body was not found during bronchoscopy in 48 cases (8.7%). The majority of the foreign bodies were seeds. Foreign bodies were removed with bronchoscopy in all cases. Pneumonia occurs in only 2.9% (29/1015) patients out of our cases. CONCLUSION Rigid bronchoscopy is very effective procedure for inhaled foreign body removal with fewer complications. Proper use of diagnostic techniques provides a high degree of success, and the treatment modality to be used depending on the type of the foreign body is mostly satisfactory.
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Affiliation(s)
- Nader Saki
- Apadana Clinical Research Center, Apadana hospital, Ahwaz, Iran
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80
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Airway foreign body removal by flexible bronchoscopy: experience with 1027 children during 2000-2008. World J Pediatr 2009; 5:191-5. [PMID: 19693462 DOI: 10.1007/s12519-009-0036-z] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2008] [Accepted: 02/02/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Foreign body aspiration (FBA) into the tracheobronchial tree is a common problem in children necessitating prompt recognition and management. This study aimed to report our experience in airway foreign body removal by flexible bronchoscopy in children. METHODS A total of 1027 patients with FBA were reviewed retrospectively. They were 626 boys and 401 girls aged from 5 months to 14 years with a median age of 17 months. The clinical manifestations, radiological findings, bronchoscopic findings and complications of the procedure were analyzed. RESULTS Among the patients, only 53.4% had a definite history of FBA. The most frequent symptom was paroxysmal cough (84.3%), followed by stridor or wheezing, fever and dyspnea. Chest X-ray showed emphysema in 68.8% of the patients, atelectasis in 13.3% and bronchopneumonia in 56.3%. A bronchoscope was inserted intranasally in most children, but through mouth and endotracheal tube in 17 and 3 children, respectively. Foreign bodies were removed successfully by flexible bronchoscopy with disposable grasping forceps or biopsy forceps in 938 (91.3%) of the patients. The other 89 patients turned to rigid bronchoscopy. During the procedures, 132 (12.9%) of the patients showed transient hypoxia, which was alleviated by oxygen supplement and/or temporary cessation of the procedure. A small amount of bleeding was found in 17 patients and bradycardia in 3. Air leak and laryngeal edema were noted in 2 patients and relieved within 24 hours. CONCLUSIONS Flexible bronchoscopy is useful and safe in retrieving airway foreign bodies in children. With skilled personnel and perfect equipments, flexible bronchoscopy could be considered as the first choice for the removal of airway foreign body.
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81
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Lees NJ, Singh S. An unexpected hazard of indwelling temperature monitoring. Intensive Care Med 2009; 35:1653-4. [PMID: 19506832 DOI: 10.1007/s00134-009-1516-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2009] [Indexed: 11/30/2022]
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82
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Al-Sarraf N, Jamal-Eddine H, Khaja F, Ayed AK. Headscarf pin tracheobronchial aspiration: a distinct clinical entity. Interact Cardiovasc Thorac Surg 2009; 9:187-90. [PMID: 19470499 DOI: 10.1510/icvts.2009.207548] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Foreign body (FB) aspiration is commonly seen in children and less commonly in the elderly. However, due to some social and cultural factors, a distinct group of tracheobronchial FB aspiration is increasingly recognized. We sought to assess our experience with such entity. A retrospective review of all cases with veil pin tracheobronchial FB aspiration in a single center over a 13-year period was carried out. There were 35 cases of headscarf tracheobronchial FB aspiration. All were females with mean age of 14 years. All patients experienced coughing and all had positive chest radiography findings. Commonest anatomical location was right main bronchus (32%) followed by left main bronchus (23%). Tracheal pins occurred in 17%. Rigid bronchoscopy was used more often than flexible bronchoscopy (83% vs. 17%, respectively). Repeat bronchoscopy was required in two cases (6%). Thoracotomy was required in one patient (3%). There were no complications or hospital deaths. Headscarf pin aspiration is seen in middle-aged women who inappropriately place the pins between their lips prior to securing their veils. Bronchoscopy is the treatment modality of choice and surgery is rarely required. Preventative educational strategies should be implemented to reduce such an avoidable risk.
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Affiliation(s)
- Nael Al-Sarraf
- Department of Thoracic Surgery, Chest Disease Hospital, Kuwait.
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83
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Horo K, Kouassi AB, Tea BZ, Assa L, Icthy VM, Folquet A, Godé VC, Ahui BJM, Cardenat M, Achi V, N'dhatz-Sanogo M, Anon JC, N'gouan JM, N'gom A, Koffi N, Aka-Danguy E. [Removal of an intratracheobronchial foreign body opaque to X-rays in a child within a context of inadequate medical technical equipment]. REVUE DE PNEUMOLOGIE CLINIQUE 2009; 65:97-100. [PMID: 19375049 DOI: 10.1016/j.pneumo.2008.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2008] [Revised: 12/17/2008] [Accepted: 12/17/2008] [Indexed: 05/27/2023]
Abstract
Intratracheobronchial foreign bodies are common accidents in children. In developed countries, the removal of these intratracheobronchial foreign bodies is performed with flexible or rigid fiberoptic bronchoscopy. Resorting to surgery is rare. In the inadequate medical context described, suitable medical technical equipment doesn't exist. Removal alternatives are necessary in order to avoid sanitary evacuation which is not always within patients' means. In this study, the authors describe the removal of an intratracheobronchial foreign body opaque to X-rays with foreign body forceps. The forceps, passed through the orotracheal intubation probe, were guided by an image intensification system in a traumatology operating theatre.
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Affiliation(s)
- K Horo
- Service de pneumologie, CHU de Cocody, BP 582 Abidjan cedex 3, Côte d'Ivoire.
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84
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Ugrinović AB, Djukić VB, Erdevicki LV, Arsenijević SD, Milovanović JP, Andrić SD, Radoić NN. [Foreign bodies of the lower respiratory tract]. ACTA CHIRURGICA IUGOSLAVICA 2009; 56:127-130. [PMID: 20218117 DOI: 10.2298/aci0903127u] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Aspiration of foreign bodies of the lower respiratory tract is the most common cause of accidental death in children under 6 years of age in the United States. The aim of the study was to actualize the problem of foreign bodies in modern society, to determine the most common types of foreign body, who and why usually aspires foreign body, whether the incidence is changing, and to define principles for optimal prevention. During our five-year study, we had 166 cases of aspiration of foreign bodies of the lower respiratory tract. The incidence is highest in children under three years of age (54.8%). Cough (94.6%) and breathing difficulties (78.9%) were the dominated symptoms. The majority of aspirated objects were grain (peanuts, walnuts, sunflower seeds)--29.5%. Localization of foreign bodies was mainly in the right and left main bronchus, and the most common complications were atelectasis and emphysema. All patients had undergone a rigid upper tracheobronchoscopy and foreign body was found in 80 patients (48%). There was no need to perform neither tracheotomy, nor any further surgical treatment, as for example thoracotomy, in any patient. Good education is the best prevention.
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Affiliation(s)
- A B Ugrinović
- Klinika za ORL i maksilofacijalnu hirurgiju, KC Srbije, Beograd
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85
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Kadmon G, Stern Y, Bron-Harlev E, Nahum E, Battat E, Schonfeld T. Computerized Scoring System for the Diagnosis of Foreign Body Aspiration in Children. Ann Otol Rhinol Laryngol 2008; 117:839-43. [DOI: 10.1177/000348940811701108] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: Foreign body aspiration (FBA) is a life-threatening event in children. The gold standard for diagnosis is bronchoscopy, but there is no consensus regarding indications for the procedure. The aim of this study was to formulate a predictive model for assessing the probability of FBA in suspected cases as an aid in the decision to perform diagnostic bronchoscopy. Methods: The files of 150 patients who underwent bronchoscopy for suspected FBA at our center between 1996 and 2004 were reviewed for medical history, physical examination, and radiologic studies. The findings were analyzed by logistic regression. Results: Using the file data, we formulated a predictive model wherein each parameter received a numeric coefficient representing its significance in evaluating suspected FBA. The most significant parameters were age 10 to 24 months, foreign body in the child's mouth and severe respiratory complaints during the choking episode, hypoxemia, dyspnea or stridor following the acute event, unilateral signs on lung auscultation, abnormal tracheal radiogram, unilateral infiltrate or atelectasis, and local hyperinflation or obstructive emphysema on chest radiogram. Conclusions: In our predictive model, every case of suspected FBA can be assigned a score based on the specific parameters present, which is then entered into a probability formula to determine the likelihood of a positive diagnosis. This model may serve as a useful tool for deciding on the use of bronchoscopy in all children with suspected FBA.
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86
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Osman EZ, Swift A. Management of foreign bodies in the ears and upper aerodigestive tract. Br J Hosp Med (Lond) 2008; 68:M189-91. [PMID: 18087849 DOI: 10.12968/hmed.2007.68.sup11.27695] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- E Z Osman
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Aintree, Liverpool
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87
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Lorenzo Dus MJ, Cases Viedma E, Sanchis Aldás JL. [Foreign body aspiration during extubation]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2008; 55:190-191. [PMID: 18401997 DOI: 10.1016/s0034-9356(08)70542-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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88
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Moon SK, Lee JM, Jeong HB, Song JY, Kim SK, Lee SH, Yoon HK, Lee SY, Kim SC, Moon HS. A Case of Radiolucent Foreign Body (Temporary Resin Bridge) Aspiration Accompanied by Inflammatory Polyps. Tuberc Respir Dis (Seoul) 2008. [DOI: 10.4046/trd.2008.64.6.456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Seol Kyung Moon
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Ji Myoung Lee
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Hae Bin Jeong
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Joo Yong Song
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Sung Kyoung Kim
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Sang Haak Lee
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Hyeong Kyu Yoon
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Sook Young Lee
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Seok Chan Kim
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Hwa Sik Moon
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
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Pinzoni F, Boniotti C, Molinaro SM, Baraldi A, Berlucchi M. Inhaled foreign bodies in pediatric patients: review of personal experience. Int J Pediatr Otorhinolaryngol 2007; 71:1897-903. [PMID: 17936370 DOI: 10.1016/j.ijporl.2007.09.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2007] [Revised: 08/29/2007] [Accepted: 09/02/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Foreign bodies (FBs) are a life-threatening event in children that require early diagnosis and prompt successful management. The ideal means of FB removal is rigid bronchoscopy under general anesthesia, although the choice between spontaneous or controlled breathing and the type of drug used are still subjects of discussion. We made a review of the literature and report our experience on FB inhalation, nature and location of FB, diagnostic method, prediction, perioperative complications, type of anesthesia, ventilation and total duration of the surgical procedure. METHODS Forty-six children undergoing rigid bronchoscopy for suspect FB aspiration were retrospectively assessed. Relevant clinical and radiological findings were retrieved. During endoscopic procedures induction and maintenance of anesthesia were performed by intravenous or volatile drugs associated with topical airway lidocaine under spontaneous breathing. RESULTS The most common symptoms were cough and dyspnea. Radiological examination was beneficial in 34 patients. At bronchoscopy, organic and inorganic FBs were located largely in bronchial tree and removed in 40 of the 46 children. All patients maintained spontaneous ventilation using volatile and intravenous anesthesia in 22 and 24 children, respectively. The mean surgical time was 79 min. Perioperative complications such as bronchospasm, bleeding and desaturation were observed in five patients. CONCLUSIONS FB inhalation is an uncommon life-threatening event in pediatric patients that can manifest with various symptoms. Rigid bronchoscopy is the procedure of choice for diagnosis and management of FB inhalation in pediatric patients. Spontaneous ventilation can be considered safe, using either volatile or intravenous agents. Perioperative complications were not correlated with either the choice of agent (volatile or intravenous) or the duration of surgery. A close collaboration between anesthesiologists and otorhinolaryngologists and a long-standing experience in pediatric airway emergencies are the key factors for obtaining good results.
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90
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Dynamic Visualization of Breath Sound Distribution in Suspected Foreign Body Aspiration. ACTA ACUST UNITED AC 2007. [DOI: 10.1097/lbr.0b013e3180959ad8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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91
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Gencer M, Ceylan E, Koksal N. Extraction of Pins from the Airway with Flexible Bronchoscopy. Respiration 2007; 74:674-9. [PMID: 17476095 DOI: 10.1159/000102302] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2006] [Accepted: 12/06/2006] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Tracheobronchial foreign body aspiration is a worldwide health problem which often results in life threatening complications. Standard flexible bronchoscopy (FB) is used increasingly in the treatment of tracheobronchial foreign body aspiration in adults and older children, especially in the removal of aspirated foreign bodies which have entered into the peripheral bronchi. OBJECTIVES In the present study, we discuss how to minimize complications and increase the success rate of FB in the aspiration of pins, and recommend techniques to facilitate the application. METHODS The study was performed at a community hospital in Van, the Harran University Hospital in Sanliurfa and the Sutcuimam University Hospital in Kahramanmaras, Turkey. Between 2000 and 2005, 23 female patients between the ages of 12 and 23, who were admitted to the clinics and diagnosed as having tracheobronchial headscarf pin aspirations were included in our study to evaluate the efficiency of FB. Diagnosis of the patients was established by history, FB and radiological methods. All patients received transoral FB under local anesthesia. RESULTS FB was successfully applied in all cases. During removal, the pins in 2 patients dropped at the proximal trachea and subglottic zone, and were ingested into the gastrointestinal track. In both cases, the pins were spontaneously excreted from the body in the stool within one day. No other complication was detected in the other patients during or following bronchoscopy. CONCLUSIONS Our study suggests that FB is a safe, easy and successful method used in the removal of foreign bodies, such as pins, from the tracheobronchial trees. By employing FB, indications of thoracotomy and other invasive methods can be reduced especially in the cases of pins localized in distal airways and in the evaluation of suspected foreign bodies.
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Affiliation(s)
- Mehmet Gencer
- Department of Chest Diseases, Faculty of Medicine, Harran University, Sanliurfa, Turkey.
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93
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Karatzanis AD, Vardouniotis A, Moschandreas J, Prokopakis EP, Michailidou E, Papadakis C, Kyrmizakis DE, Bizakis J, Velegrakis GA. The risk of foreign body aspiration in children can be reduced with proper education of the general population. Int J Pediatr Otorhinolaryngol 2007; 71:311-5. [PMID: 17161875 DOI: 10.1016/j.ijporl.2006.10.020] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2006] [Revised: 10/25/2006] [Accepted: 10/29/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate the effect of a campaign for proper education of the public on the risk of foreign body aspiration in children. METHODS A retrospective analysis of 87 endoscopic foreign body removals in children was performed at the Department of Otorhinolaryngology, Head and Neck Surgery of the University Hospital of Crete, during the period between January 2000 and December 2004. Results were compared with those of a previous study conducted by the same Department during the period between 1991 and 1999. RESULTS A foreign body was discovered in 44 cases, while in 43 cases there were no findings. Twenty-one foreign bodies (47.73%) were found in the right main bronchus, 20 foreign bodies (45.45%) were found in the left main bronchus and 3 (6.82%) in the trachea. Both crude and age-standardized bronchoscopy rates appear to be lower in the time period 2000-2004, as compared to the time period prior to the educational program. CONCLUSIONS The decline in the total number of bronchoscopies during recent years has been a result of a campaign for proper education of the public and especially parents, caretakers and families. All aspects of the educational campaign are described in detail. The risk of high morbidity and mortality from foreign body aspiration makes it mandatory to increase even more the awareness of the general population.
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Affiliation(s)
- A D Karatzanis
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Crete, School of Medicine, Heraklion, Crete, Greece
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YILMAZ A, DAMADOGLU E. Occult bronchial foreign body in the middle lobe in an adult: should it be removed: Response. Respirology 2006. [DOI: 10.1111/j.1440-1843.2006.00953.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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95
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Yüksel M, Ozyurtkan MO, Laçin T, Yildizeli B, Batirel HF. The role of fluoroscopy in the removal of tracheobronchial pin aspiration. Int J Clin Pract 2006; 60:1451-3. [PMID: 16669829 DOI: 10.1111/j.1742-1241.2005.00801.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
In this study, we investigated the role of fluoroscopy in the bronchoscopic removal of aspirated pins. Of 373 patients who underwent bronchoscopy for presumed tracheobronchial foreign body aspiration, 56 pin aspiration cases were selected and divided into two groups according to whether fluoroscopic guidance was required (group I) or not (group II). The localisation of foreign bodies, mortality and morbidity ratios and the duration of the procedures were investigated. Pin aspiration percentage was 15. Pins were mostly located in peripheral airways in group I, and in central airways in group II (p < 0.05). The mean duration of the procedure was 42 +/- 30 min in group I and 17 +/- 13 min in group II (p < 0.01). There was no mortality. Morbidity percentage was 7 in group I and 12 in group II (p > 0.05). No thoracotomy was required in any cases. Fluoroscopic guidance is safe and carries no additional morbidity and mortality and can be used for pins in the tracheobronchial tree.
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Affiliation(s)
- M Yüksel
- Department of Thoracic Surgery, Marmara University Medical Faculty, Istanbul, Turkey.
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96
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Soysal O, Kuzucu A, Ulutas H. Tracheobronchial foreign body aspiration: a continuing challenge. Otolaryngol Head Neck Surg 2006; 135:223-6. [PMID: 16890072 DOI: 10.1016/j.otohns.2005.09.035] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2005] [Accepted: 09/20/2005] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim was to present the features and outcomes for 140 cases of foreign body aspiration and to discuss specific problems and new management recommendations. STUDY DESIGN AND SETTING Records were retrospectively reviewed and the following data were recorded for each patient: age, sex, symptoms, duration of symptoms, findings on physical examination and chest radiography, location and type of foreign body, complications related to aspiration itself or to extraction, and outcome. RESULTS Seventy-eight (55.7%) patients presented within 24 hours of aspiration. The most common symptoms and findings were cough, dyspnea-stridor, decreased breath sounds, radiopaque foreign body, air trapping, and atelectasis. All 140 patients underwent rigid bronchoscopy, and 110 had the foreign material extracted via the scope. No foreign body was detected bronchoscopically in 25 cases. In the other 5 cases, the material was visualized but could not be removed via the scope, and 3 of these patients required thoracotomy for removal. Eleven patients developed morbidity after bronchoscopy. CONCLUSIONS History suggestive of foreign body aspiration is a definite indication for bronchoscopy, and bronchoscopic extraction should only be performed by experts. Each case tends to present different challenges, and endotracheal intubation and tracheotomy may be required.
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Affiliation(s)
- Omer Soysal
- Inonu University Faculty of Medicine, Turgut Ozal Medical Center, Department of Thoracic Surgery, 44315 Malatya, Turkey.
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Sharma M, Lewis C, Lewis ME, Marzouk JFK. Prawns masquerading as endobronchial tumours. Respiration 2005; 73:826-9. [PMID: 16330872 DOI: 10.1159/000090052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2004] [Accepted: 01/12/2005] [Indexed: 11/19/2022] Open
Abstract
This report details the events surrounding the case of an 89-year-old woman referred for surgery with a suspected endobronchial tumour. At rigid bronchoscopy she was found to have inspissated sputum within which the remains of organic foreign bodies (king prawns) were found obstructing the left main and left upper lobe bronchi. We outline her presentation, initial diagnosis and eventual outcome, and re-emphasise the importance of bronchoscopy as a vital tool in the assessment of any endoluminal lesion of the airway.
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Affiliation(s)
- M Sharma
- Department of Thoracic Surgery, Birmingham Heartlands and Solihull NHS Trust, Bordesley Green East, Birmingham, UK
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Barton B. Is this a calcified mediastinal germ cell tumour I see before me? Radiography (Lond) 2005. [DOI: 10.1016/j.radi.2005.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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