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Inward Rotation Method

Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery

When the point is found to be buried in the
mucosa, the best and usually successful method is to grasp the pin as
near the point as possible with the side-grasping forceps, then with a
spiral motion to push the pin downward while rotating the forceps
about ninety degrees. The point is thus disengaged, and the shaft of
the pin is brought parallel with that of the forceps, after which the
point may be drawn into the tube mouth. The lips added to the
side-curved forceps by my assistant Dr. Gabriel Tucker I now use
exclusively for this inward rotation method. They are invaluable in
preventing the escape of the pin during the manipulation. A hook is
sometimes useful in disengaging a buried point. The method of its use
is illustrated in Fig. 82.

[FIG. 82.--Mechanical problem of pin, needle, tack or nail with
embedded point. If the forceps are pulled upon the pin point will be
buried still deeper. The side curved forceps grasp the pin as near the
point as possible then with a corkscrew motion the pin is pushed
downward and rotated to the right when the pin will be found to be
parallel with the shaft of the forceps and can be drawn into the tube.
If the pin is prevented by its head from being pushed downward the
point may be extracted by the hook as shown above The side curved
forceps may be used instead of the hook for freeing the point, the
author's inward rotation method. The very best instrument for the
purpose is the forceps devised by my assistant, Dr. Gabriel Tucker
(Fig. 21). The lips prevent all risk of losing the pin from the grasp,
and at the same time bring the long axis of the pin parallel to that
of the bronchoscope.]

Pins are very prone to drop into the smaller bronchi and disappear
completely from the ordinary field of endoscopic exploration. At other
times, pins not dropping so deeply may show the point only during
expiration or cough, at which times the bronchi are shortened. In such
instances the invaded bronchial orifice should be clearly exposed as
near the axis of its lumen as possible; the forceps are now inserted,
opened, and the next emergence watched for, the point being grasped as
soon as seen.

Next: Extraction Of Tacks Nails And Large Headed Foreign Bodies From The Tracheobronchial Tree

Previous: Anchoring The Foreign Body Against The Tube Mouth

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