Removal Of Foreign Bodies From The Larynx

Categories: MECHANICAL PROBLEMS OF BRONCHOSCOPIC FOREIGN BODY EXTRACTION
Sources: A Manual Of Peroral Endoscopy And Laryngeal Surgery

Symptoms and Diagnosis.--The history of a sudden choking attack

followed by impairment of voice, wheezing, and more or less dyspnea

can be usually elicited. Laryngeal diphtheria is the condition most

frequently thought of when these symptoms are present, and antitoxin

is rightly given while waiting for a positive diagnosis. Extreme

dyspnea may render tracheotomy urgently demanded before any attempts

at diagnosis are ma e. Further consideration of the symptomatology and

diagnosis of laryngeal foreign body will be found on pages 128, 133

and 143.



Preliminary Examination.--In the adult, mirror examination of the

larynx should be done, the patient being placed in the recumbent

position. Whenever time permits roentgenograms, lateral and

anteroposterior, should be made, the lateral one as low in the neck as

possible. One might think this an unnecessary procedure because of the

visibility of the larynx in the mirror; but a child's larynx cannot

usually be indirectly examined, and even in the adult a pin may be so

situated that neither head nor point is visible, only a portion of the

shaft being seen. The roentgenogram will give accurate information as

to the position, and will thus allow a planning of the best method for

removal of the foreign body. A bone in the larynx usually is visible

in a good roentgenogram. Accurate diagnosis in children is made by

direct laryngoscopy without anesthesia, but direct laryngoscopy should

not be done until one is prepared to remove a foreign body if found,

to follow it into the bronchus and remove it if it should be dislodged

and aspirated, and to do tracheotomy if sudden respiratory arrest

occur.



[157] Technic of Removal of Foreign Bodies from the Larynx.--The

patient is to be placed in the author's position, shown in Fig. 53. No

general anesthesia should be given, and the application of local

anesthesia is usually unnecessary and further, is liable to dislodge

and push down the foreign body.* Because of the risk of loss downward

it is best to seize the foreign body as soon as seen; then to

determine how best to disimpact it. The fundamental principles are

that a pointed object must either have its point protected by the

forceps grasp or be brought out point trailing, and that a flat object

must be so rotated that its plane corresponds to the sagittal plane of

the glottic chink. The laryngeal grasping forceps (Fig. 53) will be

found the most useful, although the alligator rotation forceps (Fig.

31) may occasionally be required.



* In adolescents or adults a few drops of a 4 per cent solution of

cocain applied to the laryngopharynx with an atomizer or a dropper

will afford the minimum risk of dislodgement; but the author's

personal preference is for no anesthesia, general or local.