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Mechanical Problems Of Bronchoscopic Foreign Body Extraction*
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The Extraction Of Tightly Fitting Foreign Bodies From The Bronchi
Category: MECHANICAL PROBLEMS OF BRONCHOSCOPIC FOREIGN BODY EXTRACTION
Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery
Such objects as marbles, pebbles, corks, etc., are
drawn deeply and with force by the inspiratory blast into the smallest
bronchus they can enter. The air distal to the impacted foreign body
is soon absorbed, and the negative pressure thus produced increases
the impaction. A ring of edematous mucosa quickly forms and covers the
presenting part of the object, leaving visible only a small surface in
the center of an acute edematous stenosis. A forceps with narrow,
stiff, expansive-spring jaws may press back a portion of the edema and
may allow a grasp on the sides of the foreign body; but usually the
attempt to apply forceps when there are no spaces between the
presenting part of the foreign body and the bronchial wall, will
result only in pushing the foreign body deeper.* A better method is to
use the lip of the bronchoscope to press back the swollen mucosa at
one point, so that a hook may be introduced below the foreign body,
which then can be worked up to a wider place where forceps may be
applied (Fig. 89). Sometimes the object may even be held firmly
against the tube mouth with the hook and thus extracted. For this the
unslanted tube-mouth is used.
* The author's new ball forceps are very successful with ball-bearing
balls and marbles.
[FIG. 89.--Schema illustrating the use of the lip of the bronchoscope
in disimpaction of foreign bodies. A and B show an annular edema above
the foreign body, F. At C the edematous mucosa is being repressed by
the lip of the tube mouth, permitting insinuation of the hook, H, past
one side of the foreign body, which is then withdrawn to a convenient
place for application of the forceps. This repression by the lip is
often used for purposes other than the insertion of hooks. The lip of
the esophagoscope can be used in the same way.]
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