Tracheobronchial Foreign Body Removal Research Articles

Risk factors for difficult removal of tracheobronchial foreign bodies in children by rigid bronchoscopy.

To characterize the risk factors for difficult removal of tracheobronchial foreign body (FB) by rigid bronchoscopy in children. We retrospectively analyzed clinical data of 1026 pediatric patients (age: 0-18 years) diagnosed with tracheobronchial FB between September 2018 and August 2021. All patients underwent rigid bronchoscopy as the first intervention at our hospital. Children aged 1-3 years accounted for 83.7% cases in our cohort. The most common symptoms were cough and wheeze. FBs were more frequently found in the right bronchus, and trachea FBs accounted for only 8.19% cases. The success rate of rigid bronchoscopy in a single attempt was 97.27%. 12.18% of the cases were defined as difficult removal of FB. On univariate analysis, age, CT findings (pneumonia), type of FB, diameter of FB, FB location, granulation tissue formation, and the seniority of the surgeon were identified as risk factors for difficult removal of tracheobronchial FBs. On multivariate analysis, age ≥3 years, FB diameter ≥10mm, FBs located in left bronchus, multiple FBs, granulation tissue, and the seniority of surgeon (<3 years, ≥5 years) were independent risk factors for difficult removal. Age, FB diameter, location of FB, granulation tissue formation, and the seniority of the surgeon were risk factors for difficult removal of FBs by rigid bronchoscopy.

TOOTH IN THE LUNG: CASE REPORT OF A TOOTH ASPIRATED DURING DENTAL EXTRACTION

TOOTH IN THE LUNG: CASE REPORT OF A TOOTH ASPIRATED DURING DENTAL EXTRACTION

ACCIDENTAL ASPIRATION AFTER INTENTIONAL INGESTION OF A NAIL IN A YOUNG FEMALE

ACCIDENTAL ASPIRATION AFTER INTENTIONAL INGESTION OF A NAIL IN A YOUNG FEMALE

The Role of Tracheostomy in Bronchoscopic Removal of Tracheobronchial Foreign Bodies in Port Harcourt, Nigeria

Background: Foreign body (FB) aspiration causing obstruction to the tracheobronchial tree is an ENT emergency. Removal is usually done by Bronchoscopy. Rigid or telescopic, depending on what is available at the centre. However, successful removal and stable postoperative period may not be achieved without tracheostomy as an additional procedure. Sometimes, thoracotomy and bronchotomy may be done to achieve a successful treatment. Method A total of thirty (30) cases were recorded in this study, information retrieved from operating theatre, ENT and surgical wards. Retrieving information recorded, were age, gender, presenting symptoms and type of foreign body recorded. Results of chest x-ray were also relevant and recorded. Results Both rigid and the telescope were used in retrieval of foreign bodies in those cases, (30 cases), however, six (6) cases required tracheostomy for successful treatment. The indication of tracheostomy was basically persistent obstructive symptoms despite removal of foreign body. Conclusion Tracheostomy is sometimes mandatory in successful bronchoscopic removal of tracheobronchial foreign bodies, especially when the foreign body is vegetative.

Application of rigid bronchoscopy for emergent removal of tracheobronchial foreign body in paediatric cases: a learning curve study.

To explore the factors associated with the operative duration for paediatric tracheobronchial foreign body removal by rigid bronchoscopy, and to analyse the learning curve for mastery of the rigid bronchoscopy skill. A retrospective study was performed of paediatric cases of tracheobronchial foreign body removal by rigid bronchoscopy in our department from January 2007 to July 2019. Multivariate Cox regression analysis was used to analyse the factors associated with the operative duration. In addition, the learning curves for two doctors were evaluated by curve-fitting regression analysis. A total of 410 paediatric cases of tracheobronchial foreign body removal by rigid bronchoscopy were evaluated. The operative duration was significantly influenced by the skill of the doctor. The learning curves for both doctor A and doctor B demonstrated two typical phases: an initially rapidly changing learning phase followed by a steady consolidation phase. The operative duration for paediatric tracheobronchial foreign body removal by rigid bronchoscopy was associated with the skill of the doctor. In order to fully master the rigid bronchoscopy technique, doctors should perform a minimum number of procedures to pass the learning phase and reach the consolidation phase.

ENDOBRONCHIAL FOREIGN BODY ASPIRATION MIMICKING AN ENDOBRONCHIAL TUMOR

TOPIC: Procedures TYPE: Fellow Case Reports INTRODUCTION: Aspiration of foreign body (FB) into the airways may have an indolent presentation in adults. Although the majority of FB aspiration cases can be diagnosed easily and accurately by radiography and bronchoscopy, some patients are misdiagnosed as having endobronchial tumors. We describe an interesting case of bronchus intermedius FB that mimicked an endobronchial tumor. CASE PRESENTATION: A 61-year-old, male long-time heavy smoker with history of excessive alcohol use and stroke with residual left-sided hemiparesis presented with a 3-month history of worsening dry cough, hemoptysis and dyspnea. Chest computed tomography revealed occlusion of the bronchus intermedius with an enhancing lesion highly suspicious for an obstructing bronchial mass, along with moderate pleural effusion and enlarged subcarinal lymphadenopathy. Thoracentesis of the pleural effusion showed exudative fluid with predominantly neutrophilic cells that was negative for malignancy on cytology twice. Flexible bronchoscopy a firm, endobronchial lesion causing near total occlusion of the bronchus intermedius. Forceps endobronchial biopsy of the lesion and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) of a subcarinal lymph node revealed no malignant cells. The patient then underwent flexible bronchoscopy with removal of the occluding lesion using cryoablation. The obstructing mass appeared to be freely movable when the cryoprobe was attached to it. A basket was used to retrieve the entire resected mass, which appeared to be an aspirated pill surrounded by granulation tissue on gross examination. Histopathology of the specimen showed no evidence of malignancy but was consistent with FB aspiration. DISCUSSION: Symptoms of FB aspiration in adults may be absent and often delayed, in some reports for up to 26 months. Dysphagia and impaired cough reflex are the main mechanisms for FB aspiration. This was likely the case in our patient with a history of stroke and excessive alcohol use. In case of such an indolent presentation and invisibility of the FB on chest imaging due to formation of granulation tissue, FB aspiration may be overlooked in adults. In our patient, this was further cofounded by the presence of pleural effusion and mediastinal lymphadenopathy, which were concerning lymphadenopathy, but were likely due to post-obstructive pneumonia. Bronchoscopic cryotherapy, which resulted in the correct diagnosis in this patient, has been described in the diagnosis of benign and malignant lesions of the airways and for recanalization. CONCLUSIONS: This case highlights the importance of suspecting FB aspiration when evaluating airway lesions. Choice of a noninvasive method, such as bronchoscopic cryotherapy, for removing an endobronchial lesion, may preclude the need for thoracotomy. REFERENCE #1: 1- Alharthi BJ, et al. Occult foreign body in the lung mimicking bronchogenic carcinoma. BMJ Case Rep. 2014;2014:bcr2014207438. Published 2014 Dec 17. doi:10.1136/bcr-2014-207438 REFERENCE #2: 2- Hewlett JC, et al. Foreign body aspiration in adult airways: therapeutic approach. J Thorac Dis. 2017 Sep;9(9):3398-3409. doi: 10.21037/jtd.2017.06.137. PMID: 29221325; PMCID: PMC5708401. REFERENCE #3: 3- Sehgal IS, et al. Use of cryoprobe for removal of a large tracheobronchial foreign body during flexible bronchoscopy. Lung India. 2016 Sep-Oct;33(5):543-5. doi: 10.4103/0970-2113.188978. PMID: 27625452; PMCID: PMC5006338. DISCLOSURES: No relevant relationships by Omar Abdulfattah, source=Web Response No relevant relationships by Muath Alsharif, source=Web Response No relevant relationships by Traves Crabtree, source=Web Response no disclosure on file for Keivan Shalileh

A Novel Two Surgeons Approach to Bronchial Foreign Body Removal by Optical Instruments- An 11Years Institutional Experience.

A potentially life-threatening emergency in ENT practice is the aspiration of tracheobronchial foreign body. This commonly affects young children and requires early extraction. Successful removal provides immediate relief. However procedural complications can cause devastating morbidity like anoxic encephalopathy or instant death. The aim of this study is to describe the experience in our institution with two surgeons approach for removal of tracheobronchial foreign bodies by telescope and optical forceps. This is an observational study from the period of March 2010 to April 2021 in which 96 patients (59 males, 37 females; age range 3 months to 15 years) were diagnosed with foreign body aspiration. In all cases rigid bronchoscopy and FB removal under general anaesthesia was performed using the two surgeons technique. This technique was instituted once Storz make paediatric telescope (2.9 mm diameter 36 cm length), optical grasping forceps and optical suction were procured in March 2010. Aspirated material was inorganic or organic with varying location in right main bronchus, left main bronchus or the trachea. We highlight the OT setup, surgical algorithm and the advantages of this technique. Visual and tactile coordination between the two surgeons being the crux of this procedure; allows hands on mentoring of the next generation of budding surgeons in a real-life scenario without compromising patient safety.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12070-021-02847-8.

Tracheobronchial foreign body aspiration in children aged ≤ 2 years: the use of flexible bronchoscopy and urology stone retrieval basket in emergency setting

Objective: Tracheobronchial aspiration of foreign body in children is an emergency that can lead to major complications. In the last years flexible bronchoscopy has gained popularity for foreign bodies retrieval in the pediatric population, yet the small size of the pediatric airway and of the flexible bronchoscope channel limit the availability of instruments during the procedure. Aim of this paper is to describe our experience in treating foreign bodies tracheobronchial aspiration in children aged 2 years or less by means of flexible bronchoscope and an urology stone retrieval basket. Methods: A review of endoscopic foreign bodies removal by means of flexible bronchoscopy and urology stone retrieval basket has been carried out in children ≤ 2 years that presented at the Emergency Room of our hospital from 2005 to 2019. In the paper, we analyze characteristics of patients, timing of bronchoscopy, instruments and operative management. Results: There were 25 patients with a mean age of 20 ± 3.8 months. Organic material was the most frequent observed foreign body. Association of main bronchus and distal bronchi was the preferred site of the foreign body in 19 patients and the right side of the bronchial tree was involved in 17 cases. Complications occurred in one case. Mean operation time was 37 ± 20 minutes. Conclusions: The use of flexible bronchoscope can be helpful in handling endoscopic removal of tracheobronchial foreign bodies in toddlers. The use of the urology stone retrieval basket resulted very effective in all shapes of foreign bodies and/or when the object was located in the distal bronchi.

Çocuk Hastaların Trakeobronşiyal Yabancı Cisim Aspirasyonlarında Rijit Bronkoskopi Süresince Anestezi Uygulamalarımız

Objective: Bronchoscopy is the gold standard in the diagnosis and treatment of tracheobronchial foreign body aspiration (TBFBA) in children. Rigid bronchoscopy (RB) under general anesthesia is generally preferred in children. In this article, our anesthesia experiences during rigid bronchoscopy performed for tracheobronchial foreign body aspiration and removal of foreign bodies in children are shared. Methods: The medical records of all patients aged between 0-18 years who underwent RB under general anesthesia due to suspicion of TBFBA between January 1, 2014 and December 31, 2018 were retrospectively analyzed. Results: TBFBA was more common in boys and organic foreign body aspiration was significantly higher in patients between 13-36 months of age. Patients most frequently presented with cough and wheezing. Most of them were operated between 8 am and 4 pm. TFBs were localized in the right and left main bronchi at a similar rate. Anesthesia induction was usually achieved with iv. propofol, total intravenous anesthesia and sevoflurane inhalation was administered for maintenance of anesthesia. Except for proximally located TBFBs, intermediate-or short-acting muscle relaxants were applied to most of the cases depending on the duration of the procedure. Three patients were intubated postoperatively and transferred to intensive care unit. Respiratory distress responded to medical treatment in 25 patients. No cardiac arrest or death occurred during the procedure. Conclusion: RB and anesthesia procedure for TBYCA requires experience. There is no clear recommendation about premedication, the use of muscle relaxants should be evaluated according to the localization of TBYC. In anesthesia management, intravenous or inhalation anesthetics can be used.

Endoscopic removal of tracheobronchial foreign bodies: results on a series of 51 pediatric patients

Rigid bronchoscopy (RB) is still considered the gold standard approach for the removal of airway foreign bodies (FBs) in children; however, flexible bronchoscopy (FOB) has recently been proposed both as diagnostic and therapeutic means. Our purpose was to evaluate the outcomes of FOB, associated with the Dormia basket, for the removal of FBs. Retrospective data about 124 children who underwent bronchoscopy for the suspicion of a FB aspiration between January 2008 and January 2019 in our department were collected. In a total of 51 cases, FBs were removed through FOB or RB associated with forceps or Dormia basket. Male to female ratio was 1.8:1, mean age 30 ± 26.1months. Thirty-four (67%) FBs were directly removed through FOB, in most of the cases using Dormia basket and twelve (23%) patients underwent RB. The overall left-versus-right distribution was 57% vs. 43%. The mean retrieval procedural time was 36.29 ± 24.99min for FOB and 52.5 ± 29.74min for RB; the success rate of the procedures was 97% vs. 67%. FOB can be used not only as a diagnostic procedure, but also as the first method for the removal of airway FBs. The Dormia basket is a useful tool, especially to remove peripherally located FBs.

Removal of critical tracheobronchial foreign body by flexible scope, gastrointestinal biopsy forceps and tube exchange

Removal of critical tracheobronchial foreign body by flexible scope, gastrointestinal biopsy forceps and tube exchange

Application of Intravascular Techniques to Remove a Broken Tooth from the Airways after Emergency Intubation: A Case Report

Abstract Background: Tooth aspiration is a relatively uncommon complication of endotracheal intubation. Classic methods to remove a tooth from airways may fail in some cases, even rigid bronchoscopy, which is the method of choice for the removal of tracheobronchial Foreign Bodies (FB). Endovascular treatment is a potentially efficient treatment option in such cases. Case Presentation: We report a case of a 35-year-old man who was admitted to hospital after an emergent on-street intubation with a broken tooth lodged in the distal part of the bronchial tube. A few attempts to remove the tooth with standard laryngological endotracheal equipment were unsuccessful. Conclusion: Eventually, the tooth was successfully removed by an interventional radiologist with the use of intravascular tools including a microguidewire, balloon and loop. Usage of precise endovascular devices may be applied in successful removal of teeth or other foreign bodies from the tracheobranchial tree. Keywords Interventional Radiology; Perianesthetic Dental Injury; Treatment; Tooth Aspiration

Flexible Bronchoscopic Removal of Foreign Bodies from Airway of Children: Single Center Experience Over 12 Years

To report our experience of tracheobronchial foreign body removal in children using flexible bronchoscopy as the primary mode. Hospital records of tracheobronchial foreign body extractions between January, 2006 and January, 2018 were reviewed. Clinical presentations, radiological findings, location and types of tracheobronchial foreign bodies, types of bronchoscopes, complications and outcome of the procedures were analyzed. 283 extractions in children with median (range) age of 18 (5-168) months were reviewed. Extraction by flexible bronchoscope, using wire baskets or grasping forceps, was successful in 260 cases. No major complications were encountered. Mean (SD) time for the procedure was 31 (6.3) minutes. Airway foreign bodies can safely be removed by flexible bronchoscopy with minimal complications. This procedure can be considered the primary mode for removal of airway foreign bodies by a trained and experienced person.

Tracheobronchial foreign body in an extremely preterm infant complicated with pulmonary hemorrhage

Tracheobronchial foreign bodies in preterm neonates are extremely rare. They are usually iatrogenic and associated with dislodgement of medical devices. The narrow airways of neonates pose a challenge in removal of foreign bodies. The obstructing object or attempt of removal in itself may cause significant morbidity or mortality. We report a rare case of pulmonary hemorrhage secondary to a tracheobronchial foreign body in an extremely preterm infant and its successful removal. Literature reviews show atelectasis, pneumonia, and respiratory distress being the most common complications from a tracheobronchial foreign body. Removal of tracheobronchial foreign bodies in the narrow airways of neonates can be a grueling task with multiple risks. A high index of suspicion is needed for early detection of foreign body in the airways to avoid morbid complications.

Application of cystourethroscopy during tracheobronchial foreign body removal in children.

ObjectiveThis study aimed to describe preliminary experiences associated with removal of tracheobronchial foreign bodies (TFBs) by cystourethroscopy (CU).MethodsWe performed a retrospective analysis of 127 paediatric cases of TFB removal by CU at our centre from January 2009 to August 2016. Data that were extracted from the medical records included age, sex, location and nature of the TFBs, operation time, and complications.ResultsAll TFBs were successfully removed by CU. The mean time of the procedure was 3.38 ± 2.86 minutes. A total of 102 (80.31%) patients had successful removal of TFBs by CU during the initial trial, 19 (14.96%) were successfully treated in the second trial, and six (4.72%) required a third trial. Otolaryngologists with 2, 5, and 7 years of professional CU training showed a mean TFB removal time of 3.38 ± 2.13, 3.40 ± 3.60, and 3.37 ± 2.86 minutes, respectively. In the operations, oxygen saturation fell below 90% at an average occurrence of 0.39 times, but no patients showed a decrease below 85%. Only one patient experienced laryngeal oedema after the procedure.ConclusionCU is a useful technique and minimizes complications and operational risks during removal of paediatric TFBs.

Entrapment of a laryngotracheal topical anesthesia kit during tracheobronchial foreign body removal: a case report

BackgroundIn order to reduce the irritation of the airway during tracheobronchial foreign body (TFB) removal, tracheal surface anesthesia is usually performed using a laryngotracheal topical anesthesia (LTA) kit (LTA20, Highgreen Medical Technology Company, China), but difficulty in withdrawing the LTA kit is rarely reported. We present a case of a difficulty to withdraw the LTA kit due to its entrapment by the movement of a TFB.Case presentationA 1-year-old girl was undergoing TFB removal. After the surgeon completed the tracheal surface anesthesia, the girl suddenly suffered from bucking, leading to the dislodgment of the TFB to the subglottic region, complicating the withdrawal of the LTA applicator. At the same time, the girl’s oxygen saturation (SpO2) decreased to 91% and her heart rate dropped from 150 to 100 bpm. Atropine and succinylcholine were administered intravenously immediately, then the surgeon tried to free the TFB by pushing it back into the trachea, after which the LTA applicator was easily withdrawn, and TFB was removed successfully. The girl was discharged from hospital without any complications 2 days later.ConclusionThis case report draws our attention to a significant anesthetic clinical consideration during the application of topical anesthesia on the trachea for TFB removal. The possibility of coughing or bucking can lead to migration of the TFB with subsequent airway obstruction, so the depth of anesthesia must be sufficient to prevent harmful reflexes. Also, strong teamwork and good communication are paramount to avoid serious complications.

The effects of pressure controlled ventilation for tracheobronchial foreign body removal in children

Objective:To evaluate the effects of pressure controlled ventilation for tracheobronchial foreign body removal in children.Method: Ninety ASAⅡor Ⅲ children,aged 10 months to 3 yr,weighing 8-16 kg undergoing removal of airway foreign body were randomly divided into 3 groups(n=30 each):groupⅠpressure controlled ventilation(P)，group Ⅱ high-frequency jet ventilation(H),and group Ⅲ, reserve spontaneously breathings.Arterial blood gas analysis of Pre-operation and the end of operation,the occurrence of hypoxia during operation,the duration of operation,anesthesia emergence time and perioperative side effects were recorded. Result:The arterial blood gas analysis(PaO₂,PaCO₂,SaO₂)and SPO₂of Pre-operation in group P and H had no significant difference. The PaO₂ of the end of operations was significantly higher,and PaCO₂ was lower in group H. The occurrence of hypoxia during operation, the duration of operation,anesthesia emergence time and perioperative side effects in two group had no significant difference.Conclusion:The effects of pressure controlled ventilation and high-frequency jet ventilation for tracheobronchial foreign body removal in children were nearly the same,and pressure controlled ventilation can be commonly used in clinic.

A rare case of tracheobronchial foreign body aspiration in an adult patient admitted to the ICU: A case report and review of the literature

Abstract We report an exceedingly rare case of a foreign body (FB) discovered in the tracheobronchial tree of an adult male admitted to the intensive care unit (ICU). The patient was admitted in a state of deep coma after sustaining injuries in a road traffic accident. The head, neck and chest CT scans revealed a foreign body lodged within his tracheobronchial tree. Emergency fibre optic bronchoscopy was performed using a size 8 endotracheal tube. Multiple pieces of glass were then removed by fibre optic bronchoscope using a stone retrieval basket. This case report highlights the importance of thorough clinical and radiological evaluation of polytrauma patients. A rigid bronchoscope is the recommended treatment modality for tracheobronchial foreign body removal, followed by a flexible fibre optic scope.

Use of cryoprobe for removal of a large tracheobronchial foreign body during flexible bronchoscopy.

Foreign body (FB) inhalation in the tracheobronchial tree is an infrequently encountered event in adults. The diagnosis is suspected in the presence of a clinical history of aspiration and the presence of respiratory symptoms. Management involves confirmation by flexible bronchoscopy, which may be both diagnostic as well as therapeutic. However, in certain situations including those with large FB, FB embedded in granulation tissue or FB with very smooth margins, rigid bronchoscopy may be superior to flexible bronchoscopy in the retrieval of the FB. An alternative to rigid bronchoscopy in such situations may be the use of a cryoprobe. Herein, we describe a patient with a large tracheobronchial FB causing a complete collapse of the left lung and hypoxemia. The FB was successfully extracted using a cryoprobe during flexible bronchoscopy, obviating the need for rigid bronchoscopy.

Foreign Body Inhalation in the Adult Population: Experience of 25,998 Bronchoscopies and Systematic Review of the Literature.

Foreign body aspiration is an uncommon entity in adults. Herein, we describe our experience with flexible bronchoscopy in the removal of tracheobronchial foreign bodies in adults. We also conducted a systematic review of the literature on the topic of foreign body inhalation in adults managed with flexible bronchoscopy. The bronchoscopy database (from 1979 to 2014) was reviewed for subjects > 12 y of age with a history of foreign body aspiration managed with flexible bronchoscopy. Demographic, clinical, and bronchoscopy data were collected and analyzed. PubMed was reviewed for studies describing the use of flexible bronchoscopy for foreign body extraction in adults. During the study period, a total of 25,998 flexible bronchoscopies were performed. Of these, 65 subjects (mean age of 32.8 y, 49 males) were identified who had undergone bronchoscopy for foreign body aspiration. Nonresolving pneumonia (30.6%), direct foreign body visualization (24.6%), and segmental collapse (18.4%) were the most common radiological abnormalities. Foreign bodies were identified in 49 cases during bronchoscopy and successfully removed in 45 (91.8%) subjects with no major complications. Metallic (41%) and organic (25.6%) foreign bodies were the most common. Shark-tooth (44.9%) and alligator (32.6%) were the most commonly used forceps in retrieving the foreign bodies. The systematic review yielded 18 studies (1,554 subjects with foreign body inhalation). In adults, the proportion of flexible bronchoscopy (6 studies, 354/159,074 procedures) performed for the indication of foreign bodies among the total flexible bronchoscopies was 0.24% (95% CI 0.18-0.31). The overall success of flexible bronchoscopy (18 studies, 1,185 subjects) for foreign body extraction was 89.6% (95% CI 86.1-93.2). Foreign body aspiration is a rare indication for flexible bronchoscopy in adults. Flexible bronchoscopy has a high success rate in removal of inhaled foreign body and can be considered the preferred initial procedure for management of airway foreign bodies in adults.