Tracheal Perforation Research Articles

Laryngeal paralysis secondary to cervical bite injuries in five dogs

Case histories : Medical records of a veterinary hospital in Belgium were reviewed for dogs (n=5) that presented between 2016 and 2019 with laryngeal paralysis secondary to bite wounds to the cervical region received while fighting with other dogs . The time elapsed between the trauma and presentation was from a few hours up to 5 days. Clinical findings and treatment Bilateral laryngeal paralysis was identified in three dogs and unilateral laryngeal paralysis in two dogs via endoscopic assessment of laryngeal function. The primary concomitant lesions included tracheal injury in 3/5 dogs and oesophageal injury in 1/5 dogs. One dog with bilateral laryngeal paralysis was treated medically as no signs of dyspnoea were present. Surgical management was elected in 4/5 dogs based on evaluation of their clinical status and lesions revealed by endoscopic examination of upper gastrointestinal and respiratory tracts. Dogs underwent surgical procedures as were determined to be appropriate for treatment of the lesions identified on clinical examination, diagnostic imaging, and endoscopy. The cervical region was explored through a ventral midline approach in 2/4 cases to close tracheal perforations. Temporary tracheostomy was performed in 2/4 cases. Procedures to correct brachycephalic airway obstructive syndrome were performed in 2/4 cases. Cricoarytenoid lateralisation was performed in 2/4 dogs. Dogs were hospitalised for 2–10 days and received antimicrobial therapy before surgery and for 2–3 weeks after surgery. Physical examination and respiratory function were normal in 3/5 dogs 4–6 months after discharge. Information regarding outcomes for two cases was obtained from the owners by telephone assessment 1–6 months after surgery. The owner of each dog reported the respiratory function to be excellent. Diagnosis: Uni- or bilateral, transient or permanent laryngeal paralysis with concomitant oesophageal, tracheal, or laryngeal lesions following cervical dog bite injuries diagnosed by endoscopic examination of upper gastrointestinal and respiratory tracts. Clinical relevance: This case series describes the diagnosis and management of dogs with laryngeal paralysis secondary to cervical dog bite injuries. To the authors’ knowledge, this is the first published report documenting bilateral laryngeal paralysis secondary to cervical dog bite injuries. Clinicians should be aware of this pathology and the importance of investigating laryngeal function in dogs presenting with cervical bites, particularly those with inspiratory dyspnoea. Upper airway and digestive endoscopy are recommended for complete assessment of cervical traumatic injuries.

Erosion of Superior Vena Caval Stent into Trachea, An Unusual Cause of Hemoptysis.

Erosion of Superior Vena Caval Stent into Trachea, An Unusual Cause of Hemoptysis.

Delayed perforation of the trachea following total thyroidectomy

In this modern era, refinement of operative procedures and advanced instrumentation have made total thyroidectomy for benign and malignant diseases of the thyroid gland a safe procedure. Delayed tracheal perforation after thyroidectomy is a rare complication with very few cases reported. We present a case of a 47-year-old female with a delayed perforation in the trachea following thyroidectomy. Computerized tomogram demonstrated the defect in the trachea. Emergency exploration and closure of the rent in the trachea with a muscle patch, along with tracheostomy was done for the condition.

Immediate Postoperative Complications in Adult Tracheostomy.

ObjectiveTracheostomy is one of the oldest operations for the management of airway obstruction. With time, indications expanded to prolonged mechanical ventilation, and currently, the majority of tracheostomies are done for this reason. There are several techniques used in a tracheostomy procedure, depending on surgeon preference. Immediate complications such as bleeding, pneumothorax, pneumomediastinum, airway fire, and posterior tracheal wall perforation with esophageal injury are rare, although they do occur, and must be managed accordingly. This study aimed to assess differences in types and rates of immediate postoperative complications in patients undergoing tracheostomy when performed under general anesthesia and local anesthesia (awake tracheostomies) at a large academic institution. This is a continuing ongoing literature reporting tracheostomy adverse events.MethodsA retrospective chart review was performed to identify patients who underwent tracheostomy placement between January 1, 2013 and December 31, 2019 at the Detroit Medical Center, USA. Postoperative complications such as bleeding, pneumothorax, pneumomediastinum, airway fire, and posterior tracheal perforation were collected along with gender, age, and revision tracheostomy status. IBM SPSS Statistics (IBM Inc., Armonk, USA) was used for statistical analysis with the statical significance defined as a p<0.05.ResultsA total of 1,469 patient charts were reviewed. Of these, 1,342 met the inclusion and exclusion criteria, of which, males were 57.2% (n=768), and females were 42.8% (n=574). The age range was 18 years to 96 years (mean=58.03; SD= 15.97), and BMI range was 12-83 (mean=28.77; SD=7.885).Multinomial logistic regression was performed to determine whether age, BMI, sex, and revision tracheostomies were represented across both general and awake tracheostomy groups proportionally to their numbers in the total sample. It showed non-significant value for age (χ2=0.776, p=0.378), BMI (χ2=0.004, p=0.947), but significant value for sex (χ2=4.645, p=0.031), revision tracheostomy (χ2=18.282, p<0.001), indicating that males and revision tracheostomies over-represented in awake tracheostomies.Next, Pearson correlation analysis was performed to determine any significant linear relationship between age, sex, and tracheostomy complications. It showed a significant positive correlation between age and tracheal stomal infection [r(1,340)=0.062, p=0.022].An independent sample t-test showed a statistically significant difference between the mean pneumothorax and pneumomediastinum of general (n=1,277, mean=0.01, SD=0.088) and awake tracheostomies (n=65, mean=0.08, SD=0.269, t=2.069, p=0.043).Pneumothorax pneumomediastinum complications between the general tracheostomy and awake tracheostomy odds ratio (OR)-6.22, indicates the chance of pneumothorax /pneumomediastinum complication is 6.22 times more in awake tracheostomy than general tracheostomy. Based on the above statistical analysis, we rejected the null hypothesis.ConclusionsTracheostomy is the procedure of choice to relieve the upper airway obstruction and treat patients requiring prolonged mechanical ventilation. A slightly higher number of Immediate postoperative complications in awake tracheostomy were noticed in patients with more surgically challenging revision tracheostomies.

Iatrogenic esophageal and tracheal perforation with tracheoesophageal fistula following emergency intubation.

Iatrogenic tracheoesophageal fistula (TEF) through direct penetration of esophageal and tracheal walls is exceedingly rare. Body tissues sealing around the tube may result in delayed development of respiratory complications and diagnosis. Pneumomediastinum and pneumothorax may be absent. Maintaining the airway through TEF until tracheostomy resulted in a satisfactory outcome.

Endoscopic thyroidectomy versus conventional open thyroidectomy for early differentiated thyroid cancer

Introduction: Endoscopic thyroidectomy has been applied prudently for malignant thyroid tumors. The aim of our study was to compare the outcomes of endoscopic lobectomy and conventional open lobectomy for early differentiated thyroid cancer. Materials and Methods: From October 2018 to October 2019, 485 patients with early differentiated thyroid cancer underwent thyroid lobectomy in National hospital of Endocrinology enrolled. Of them, 235 patients underwent endoscopic lobectomy (EL) and 250 patients underwent conventional open lobectomy (OL). Results: The mean age of the patients was lower in the EL group (22,3 ± 3,6 years) than in the OL group (31,0 ± 5,8 years, P = 0,013). The ratio female/male was higher in the EL group than in the OL group (12/1 vs 7/1, P = 0,002). The operation time in the EL group was longer than in the OL group (58,4 ± 12,9 vs 42,3 ± 9 minutes, P = 0,014). However, there was no significant differences between EL group and OL group in tumor size (1,2 ± 0,2 vs 1,1 ± 0,6, P = 0,123), blood loss (12,5 ± 0,9 vs 13,6 ± 1,6ml, P = 0,457), postoperative hospital day (4,35 ± 1,4 vs 4,1 ± 1,1 days, P = 0,061), transient hypoparathyroidism (0,85% vs 0,8%, P = 0,431) or transient recurrent laryngeal nerve injury (1,27% vs 1,2%, P = 0,311). The drainage volume in the EL group was higher than in the OL group (75,5 ± 11,4 vs 54,1 ± 10,1ml, P = 0,046). Postoperative bleeding was similar in two groups (0,42% vs 0,4%, P = 0,457). There was no postoperative complications such as permanent recurrent laryngeal nerve injury, tracheal perforation, conversion to open surgery, chyle leak, surgical site infection. Patients in the EL group experienced with less pain than those in the OL group at 1 and 2 days after operation according to a visual analog scale (VAS) (P = 0,047). Wound site numbness is significantly less pronounced in the OL group (p = 0,032). Cosmetically, patients in the EL group were more satisfied than in OL group according to the questionnaire we used (P = 0,021). Conclusions: Endoscopic thyroidectomy for patients with early differentiated thyroid cancer is a safe and effective procedure with excellent cosmetic outcome. Postoperative hospital length stays and complications were similar to conventional open surgery.

Endoscopic Wedge Excisions with CO2 Laser for Subglottic Stenosis.

Endoscopic Wedge Excisions with CO2 Laser for Subglottic Stenosis.

Real-world experience of lenvatinib in patients with advanced anaplastic thyroid cancer.

We aimed to evaluate the clinical efficacy and safety of lenvatinib in patients with advanced anaplastic thyroid cancer (ATC) in real-world practice. This multicenter, retrospective cohort study included 14 patients with advanced ATC who received lenvatinib. We evaluated the response rate according to RECIST. Ten patients had de novo ATC, and lenvatinib was used as a neoadjuvant treatment in eight patients. During a median follow-up of 6.7 months, patients received lenvatinib at a median dose of 13 mg daily. Overall, four patients (29%) showed partial response, nine (64%) had stable disease, and one (7%) had progressive disease. Tumor burden was reduced in 13 patients (93%), and the median best percent change from the baseline was -15.8%. The median progression-free survival and overall survival were 5.7 months (95% confidence interval [CI], 2.2-8.3) and 6.7 months (95% CI, 3.0-8.4), respectively. All patients experienced adverse events (AEs). Most AEs were manageable but two AEs-tracheal perforation, and pneumothorax and pneumomediastinum-were life-threatening. One patient underwent flap surgery for reconstruction of their tracheal perforation, and another died of pneumothorax and pneumomediastinum, which seemed to be related to lenvatinib. In this multicenter real-world study, lenvatinib demonstrated limited clinical activity in advanced ATC. It effectively reduced the tumor burden but showed doubtful survival benefit. Although most AEs were manageable, one fatal AE was related to rapid tumor shrinkage. Further studies are needed to clarify the efficacy and optimal dose of lenvatinib in patients with advanced ATC.

Dual-wavelength fiber-optic technique to assist needle cricothyroidotomy

The traditional needle cricothyroidotomy procedure is performed blindly without any medical equipment. Complications including posterior tracheal wall perforation, accidental vessel puncture, and missed tracheal puncture are reported. Therefore, we proposed a dual-wavelength fiber-optic technique based on the technique of near-infrared spectroscopy to assist operators performing needle cricothyroidotomy in a swine model. We embedded optical fibers in a 16-gauge intravenous needle catheter. Real-time data were displayed on an oscilloscope, and we used the program to analyze the data immediately. The change of optical density corresponding to 690-nm and 850-nm wavelengths and hemoglobin parameters (HbO2 and Hb concentrations) was analyzed immediately using the program in the laptop. Unique and significant optical differences were presented in this experiment. We could easily identify every different tissue by the change of optical density corresponding to 690-nm and 850-nm wavelengths and hemoglobin parameters (HbO2 and Hb concentrations). Statistical method (Kruskal-Wallis H test) was used to compare differences in tissues at each time-point, respectively. The p values in every tissue in optical density change corresponding to 690 nm and 850 nm were all < 0.001. Furthermore, the p values in every tissue in Hb and HbO2 were also all < 0.001. The results were statistically significant. This is the first and novel study to introduce a dual-wavelength embedded fibers into a standard cricothyroidotomy needle. This proposed system might be helpful to provide us real-time information of the advanced needle tip to decrease possible complications.

Tracheal perforations: Finding the ideal treatment option

Tracheal perforations: Finding the ideal treatment option

The Adoption of Ultrasound-guided Radiofrequency Ablation of Thyroid Nodules in the United States.

The Adoption of Ultrasound-guided Radiofrequency Ablation of Thyroid Nodules in the United States.

International Multi-institutional Experience with the Transoral Endoscopic Thyroidectomy Vestibular Approach.

Background: Surgical approaches to thyroidectomies have undergone a rapid evolution over the past three decades. Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is currently the latest remote access procedure for the treatment of benign and malignant thyroid disease. The purpose of this article is to present the results of TOETVA from five different international institutions. Materials and Methods: From 2016 to 2019, 152 TOETVA procedures were performed on 149 patients at five separate international institutions. Outcomes were analyzed from a prospectively maintained database. There were 12 (8%) men and 137 (92%) women with mean ages of 41.5 ± 10.3 (27-69) and 46.9 ± 1.8 (17-78), respectively. Results: There were 3 (2%) cases that required conversion from the endoscopic approach to an open procedure. A thyroid lobectomy was performed in 111 (73.0%) cases, total thyroidectomy in 38 (25.0%) cases whereas a completion thyroidectomy in 3 (2.0%) cases. Mean operative times were 161.8 ± 42.4 (83-304) minutes for the lobectomy, 213.4 ± 71.7 (120-430) minutes for the total thyroidectomy, and 136.7 ± 109.8 (64-263) minutes for the completion thyroidectomy. The final pathology report revealed 107 (70.4%) benign nodules, 44 (28.9%) nodules with underlying papillary thyroid carcinoma, and 1 (0.7%) case with Hurthle cell carcinoma. Of the 152 cases, 7 (4.7%) patients developed temporary hypoparathyroidism. There were 5 (3.3%) patients who developed transient recurrent laryngeal nerve (RLN) injury and 3 (2.0%) with persistent injury of the RLN. Temporary lower lip numbness was noted in 51 (33.6%) patients whereas 1 (0.7%) patient was noted to have persistent numbness. We reported 57 (38.5%) patients with temporary chin numbness, 9 (5.9%) patients with skin injuries, and 2 (1.3%) with tracheal perforation. Conclusion: To date, the literature and the outcomes from these 5 international institutions have determined that, in select patients, TOETVA can be as safe and efficacious as the traditional trans-cervical technique for the treatment of specific thyroid pathologies.

Tracheal Diverticulum Perforation with Mediastinal Emphysema During Lung Cancer Surgery Under General Anesthesia: a Case Study

Tracheal Diverticulum Perforation with Mediastinal Emphysema During Lung Cancer Surgery Under General Anesthesia: a Case Study

Usefulness of flexible bronchoscopy for securing the airway in traumatic tracheal perforation during tracheostomy with development of tracheo-esophageal fistula

Usefulness of flexible bronchoscopy for securing the airway in traumatic tracheal perforation during tracheostomy with development of tracheo-esophageal fistula

Generalized Subcutaneous Emphysema Secondary to Pneumomediastinum in a Newborn kitten

Background: Pneumomediastinum is a rare entity characterized by the introduction of air into the mediastinum. Primary or spontaneous pneumomediastinum may occur in the absence of any disease whereas secondary pneumomediastinum may be due to a number of precipitating factors. The clinical picture is severe and the onset is acute. The present report describes the clinical presentation, treatment, and the findings of a forensic investigation of a case of generalized subcutaneous emphysema secundary to pneumomediastinum in a newborn kitten. Case: A newborn kitten was presented to a veterinary climic with a history of generalized air accumulation in the subcutaneous tissue of acute onset which was noted whenever the animal suckled. Clinical care and radiographic examination were performed. Radiographic findings included areas of radiolucency within the subcutis suggestive of generalized subcutaneous emphysema. In the thoracic cavity, there was ventral displacement of the thoracic trachea and increased radiolucency in the cranial mediastinum suggestive of pneumomediastinum. There was loss of definition of the cervical trachea suggestive of tracheal rupture. Based on the radiographic findings, the clinician decided to aspirate the air accumated within the subcutis using a needle and a syringe. However, this emphysema rapidly formed after the subcutaneous air was aspirated. Euthanasia was elected due to the poor prognosis and the animal was submitted for necropsy. Main gross findings included traumatic intercostal laceration adjacent to the lungs under the axilla and tracheal perforation. Tracheal perforation resulted in persistent air leakage from the trachea causing pneumomediastinum which evolved into generalized subcutaneous emphysema causing the animal to inflate as air became trapped within the subcutis imparting a blown up appearance to the cat. Microscopically pulmonary collapse was observed. Symptomatic treatment was instituted and consisted of puncturing the distended skin with needle and syringe. Percutaneous drainage of the subcutaneous air was unsuccessful.Discussion: In the present case, the diagnosis of generalized subcutaneous emphysema due to pneumomediastinum in a newborn kitten was based on the history, clinical signs, radiographic findings, and gross necropsy lesions. However, the histopathological findings were non-specific. The present case is an example of secondary pneumomediastinum. Tracheal perforation resulted in massive air penetration into the mediastinum. Generalized subcutaneous emphysema developed as a complication of the pneumomediastinum. Queens carry their offspring using their mouth. We suggest that the tracheal lesion is a penetrating tracheal trauma and that this injury was inflicted by the mother's canine teeth as she transported the kitten with the animal's neck and chest inside her mouth. There was no history that the kitten was attacked by other animal or of any other type of trauma. Initial conservative treatment consisted of puncturing the skin in order to release subcutaneous air and relieve pain. Oxygen supply was not considered due to practical reasons since such supportive therapy would worsen the clinical picture of the patient. Necropsy findings were of major importance to establish a definitive diagnosis. Gross lesions included tracheal perforation, which caused pneumomediastinum through air leakage into the mediastinum and lead to the subcutaneous emphysema. We conclude that unintentional traumatic injuries in a newborn kitten caused by the queen should be considered as a cause of pneumomediastinum and subcutaneous emphysema. The clinical picture is severe, of acute onset, and exhibits a rapidly progressive course.

Effective Lenvatinib Treatment Complicated with Secondary Tracheocutaneous Fistula in Patients with Advanced Anaplastic Thyroid Carcinoma

Anaplastic thyroid carcinoma (ATC) is a fatal disease with a poor prognosis. Lenvatinib is an oral multi-targeted tyrosine kinase inhibitor (TKI) which is approved in Japan for the treatment of ATC. Data of treatment response and adverse effects of lenvatinib in ATC patients is still relatively scarce, especially in non-Japanese patient populations. Here we report dramatic treatment effects of lenvatinib in two patients with stage IVc ATC, who later developed significant morbidities including tracheal perforation and fistula formation. Our cases demonstrate the efficacy and provide cautionary information for treatment of ATC. In treating advanced ATC patients with lenvatinib, close monitoring is highly recommended.

Foreign Body of the Right Main Bronchus with Tracheal Perforation (Case Report)

The article describes a rare case of a foreign body removal from the tracheobronchial tree of a child. In the acute period of aspiration, the girl developed severe hypoxia, a terminal condition caused by the standing of a foreign body in the infraglottic space, a spasm of the vocal cords and obstruction of the lumen of the respiratory tract. In emergency tracheal intubation in a medical institution at the place of residence, the foreign body was moved more distally, which allowed to restore lung ventilation, stabilize the child’s condition and transport her to a specialized medical institution where X-ray and endoscopic examination were performed. It was found that the one-year-old patient had a screw cap tightly wedged into the lumen of the right main bronchus, and the screw’s opposite sharp end punched the left wall of the trachea above its carina. There was a potentially high risk of perforation of the main vessels of the mediastinum with massive bleeding and an unfavorable outcome. Endoscopic removal of a foreign body was technically impossible due to the peculiarity of its transverse arrangement and perforation of the wall, which served as an indication for emergency thoracotomy. A longitudinal sternotomy was performed, providing good access to the distal trachea, the main bronchi and the great vessels. Then we performed transverse bronchotomy in the initial part of the right main bronchus on half of its circumference, removed the foreign body, sutured the wall of the bronchus. The length of the extracted self-drilling screw was 35 millimeters. Postoperative early and late periods went without complications. At follow-up, mucosal surface of the right main bronchus was pink, the vascular pattern was visible, the bronchus was freely passable, not deformed.

Use and perceived safety of stylets for neonatal endotracheal intubation: a national survey.

To examine the use and perceived safety of stylets for neonatal intubation in a cohort of providers in the United States. A cross-sectional survey was sent to members of the American Academy of Pediatrics Section on Neonatal-Perinatal Medicine. A total of 640 responses were received. 57% reported using a stylet 'every time' or 'almost every time' they intubated. The preferred stylet bend was a smooth bend of <30 degrees. 71% of respondents believed that stylets were safe. Reported complications from stylet use included tube dislodgement during stylet removal (32%), airway injury with bleeding (9%), and tracheal perforation (2%). Stylet use was common. There was fair consistency on preference for stylet bend and position. Stylet use was believed to be safe, but complications were observed by many respondents. Additional studies are needed to examine the risks and benefits of stylet use during neonatal intubation.

An audit of ingested and aspirated foreign bodies in children at a university hospital in South Africa: The Pietermaritzburg experience.

The ingestion or aspiration of foreign bodies (FBs) by children is a common problem around the world. Our centre in Pietermaritzburg, South Africa, has a dedicated paediatric surgical service, and all patients with an ingested or aspirated FB are managed under the direct care of a paediatric surgeon. To review our centre's experience with this problem by means of a retrospective audit and use the data to develop and refine appropriate local management guidelines. Grey's Hospital has a hybrid electronic medical registry (HEMR) that captures patient data on admission, after a procedure and on discharge. The HEMR was reviewed and all patients with an appropriate International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10) code indicating an ingested or aspirated FB were identified and retrieved for review. A total of 105 cases of FB ingestion or aspiration in children &lt;12 years of age from January 2012 to December 2014 were identified from the HEMR. The patients' ages ranged from 4 months to 10 years (mean 3 years and 6 months), and 59.0% (n=62) were male and 41.0% (n=43) female. A total of 107 FBs were removed (two patients each had two coins removed). The commonest FBs were coins (n=77, 71.9%), followed by batteries (n=6, 5.6%), plastic toys (n=5, 4.7%), buttons (n=5, 4.7%), screws/washers (n=3, 2.8%), seeds (n=2, 1.9%), needles (n=2, 1.9%), bones (n=2, 1.9%), a marble (n=1, 0.9%), a rubber eraser (n=1, 0.9%), a curtain hook (n=1, 0.9%), a nail (n=1, 0.9%) and a wood speck (n=1, 0.9%). Of the FBs, 67 (62.6%) were in the oesophagus, 17 (15.9%) in the respiratory system, 14 (13%) in the intestine and 9 (8.4%) in the oral cavity. The average time from ingestion/aspiration to presentation was &lt;48 hours. Of the FBs, 67 (62.6%) were removed via rigid oesophagoscopy and 13 (12.1%) via rigid bronchoscopy, 13 (12.1%) were passed rectally, and 9 (8.4%) were removed via grasping forceps in the oral cavity, 4 (3.7%) via thoracotomy and 1 (0.9%) via emergency laparotomy. A total of 15 complications included mucosal ulceration/slough (n=6, 40.0%), oesophageal perforation (n=3, 20.0%), aspiration pneumonia (n=3, 20.0%), and tracheal perforation, lung collapse and contact bleed (n=1 each, 6.7%). No patient presented in respiratory distress or needed emergency airway management, and there were no deaths. The development of a dedicated paediatric surgery service and the implementation of management protocols have resulted in excellent outcomes for this problem.

An audit of ingested and aspirated foreign bodies in children at a university hospital in South Africa: The Pietermaritzburg experience

Background. The ingestion or aspiration of foreign bodies (FBs) by children is a common problem around the world. Our centre in Pietermaritzburg, South Africa, has a dedicated paediatric surgical service, and all patients with an ingested or aspirated FB are managed under the direct care of a paediatric surgeon. Objectives. To review our centre’s experience with this problem by means of a retrospective audit and use the data to develop and refine appropriate local management guidelines. Methods. Grey’s Hospital has a hybrid electronic medical registry (HEMR) that captures patient data on admission, after a procedure and on discharge. The HEMR was reviewed and all patients with an appropriate International Statistical Classification of Diseases and Related Health Problems , 10th revision (ICD-10) code indicating an ingested or aspirated FB were identified and retrieved for review. Results. A total of 105 cases of FB ingestion or aspiration in children &lt;12 years of age from January 2012 to December 2014 were identified from the HEMR. The patients’ ages ranged from 4 months to 10 years (mean 3 years and 6 months), and 59.0% ( n =62) were male and 41.0% ( n =43) female. A total of 107 FBs were removed (two patients each had two coins removed). The commonest FBs were coins ( n =77, 71.9%), followed by batteries ( n =6, 5.6%), plastic toys ( n =5, 4.7%), buttons ( n =5, 4.7%), screws/washers ( n =3, 2.8%), seeds ( n =2, 1.9%), needles ( n =2, 1.9%), bones ( n =2, 1.9%), a marble ( n =1, 0.9%), a rubber eraser ( n =1, 0.9%), a curtain hook ( n =1, 0.9%), a nail ( n =1, 0.9%) and a wood speck ( n =1, 0.9%). Of the FBs, 67 (62.6%) were in the oesophagus, 17 (15.9%) in the respiratory system, 14 (13%) in the intestine and 9 (8.4%) in the oral cavity. The average time from ingestion/aspiration to presentation was &lt;48 hours. Of the FBs, 67 (62.6%) were removed via rigid oesophagoscopy and 13 (12.1%) via rigid bronchoscopy, 13 (12.1%) were passed rectally, and 9 (8.4%) were removed via grasping forceps in the oral cavity, 4 (3.7%) via thoracotomy and 1 (0.9%) via emergency laparotomy. A total of 15 complications included mucosal ulceration/slough ( n =6, 40.0%), oesophageal perforation ( n =3, 20.0%), aspiration pneumonia ( n =3, 20.0%), and tracheal perforation, lung collapse and contact bleed ( n =1 each, 6.7%). No patient presented in respiratory distress or needed emergency airway management, and there were no deaths. Conclusions. The development of a dedicated paediatric surgery service and the implementation of management protocols have resulted in excellent outcomes for this problem.