Foreign bodies in the trachea and bronchus
◼ Foreign body aspiration can result a spectrum of changes, from minimal symptoms, to respiratory compromise, failure, and even death
◼ A foreign body aspirated into air passage can lodge in the larynx, trachea, or bronchi ◼ Site of lodgement would depend on the size and nature of the foreign body
◼ A large foreign body, unable to pass through the glottis, will lodge in the supraglottic area while the smaller one will pass down through the larynx into the trachea or bronchi ◼ Foreign bodies with sharp points, e.g. pins, needles, fish bones, etc. can stick anywhere in the larynx, or tracheobronchial tree
Etiology ◼ Foreign body aspiration is most common in children aged 6 months to 4 years. –They lack molars for proper grinding of food. –They tend to be running or playing at the time of aspiration. –They tend to put objects in their mouth more frequently. –They lack coordination of swallowing and glottic closure
◼ Adults who are unable to protect the airway, are also at risk of aspiration due to decreased airway protective mechanisms. –Mental retardation –coma, deep sleep –Alcoholism –Psychoses –Neurologic disorders
◼ foreign bodies like peanuts, beans, seeds, pins, needles are small and smooth , light in weight, even have a cusp which is round and thin. All of these character make it is easy to be aspirated ◼ Wrong way to take foreign bodies out of the oral cavity, laryngopharynx or the nose cavity
◼ Keep the pin, clasp or nail in mouth when working, sometimes aspirated in the trachea and bronchi. ◼ Unstable instrument or resected tissue glide in to the trachea when operation is doing ◼ Some suicide happen
A peanut in the right main bronchus A drawing pin in the left main bronchus
Anatomy ◼ The trachea is a 4-5 inch tube that runs through the lower neck and chest just anterior to the esophagus. It functions to conduct air between the larynx and primary bronchi ◼ In the wall of the trachea are 16-20 hyaline cartilage rings. They stiffen the wall so that the 1 inch tracheal lumen stays open and air flows unimpeded