Removal of Airway Foreign Body by Fiberoptic Bronchoscopy through a Laryngeal Mask Airway

Abstract

A male patient, 78 years old, was referred to our emergency department (ED) for what was thought to be a foreign body in the right bronchial tree. The chest roentgenogram revealed a denture (3.6×1 cm) impacted in the right main bronchus with distal consolidation. A fiberoptic bronchoscope was used in an attempt to remove the foreign body at a local hospital, but failed. After admission to our hospital, a repeat flexible bronchoscopy was performed to retrieve the foreign body under topical anesthesia, but also failed. A chest surgeon was consulted. Another bronchoscopy was performed under general anesthesia with a laryngeal mask airway. Grasping forceps were inserted through the working channel of the bronchoscope to capture the denture. The denture contained 5 false teeth. Increased experience and the development of better accessories has advanced the acceptance of the flexible bronchoscope as the preferred initial instrument for both the diagnosis and removal of airway foreign bodies in adults. With the development of the laryngeal mask airway, a flexible bronchoscopy can be performed with reasonable airway control, even with deeper sedation. For patients who cannot tolerate a fiberoptic bronchoscopy under topical anesthesia, we advise using the laryngeal mask airway with general anesthesia, because it offers a larger diameter and less resistance than an endotracheal tube, thus facilitating the bronchoscopy and the removal of the airway foreign body.