Foreign Bodies inpharynx &oesophagus
Foreign Bodies in pharynx & oesophagus
FB inPharynxCommonFBsfish bones, small sticks in foodgrain, steel woolMostcommonsitestonsils, base of tongue, valleculapyriformfossa
FB in Pharynx • Common FBs fish bones, small sticks in food grain, steel wool • Most common sites tonsils, base of tongue, vallecula, pyriform fossa
TreatmentTonsils - tongue depressor&forcepsBase of tongue - indirectlaryngoscopy & angled forcepsVallecula/ pyriform fossa-hypopharyngoscopy under GA
Treatment • Tonsils – tongue depressor & forceps • Base of tongue – indirect laryngoscopy & angled forceps • Vallecula / pyriform fossa – hypopharyngoscopy under GA
FBinOesophagusApplied anatomy of oesophagusextends fromlowerborderof C6vertebra / cricoid cartilage tocardiac opening at 11th thoracicvertebraCervical and thoracic part25 cm long in adults
FB in Oesophagus Applied anatomy of oesophagus • extends from lower border of C6 vertebra / cricoid cartilage to cardiac opening at 11th thoracic vertebra • Cervical and thoracic part • 25 cm long in adults
ofConstrictionsoesophagusCricopharyngeal junction - upperend,15cmfrom upper incisor,most narrow part of oesophagus Cardiac sphincter - lower end, 40cm from upper incisor, anothernarrow partAortic arch and left mainbronchuscross at23and 25cm
Constrictions of oesophagus • Cricopharyngeal junction – upper end, 15cm from upper incisor, most narrow part of oesophagus • Cardiac sphincter – lower end, 40 cm from upper incisor, another narrow part • Aortic arch and left main bronchus cross at 23 and 25 cm
Typess of FBChildrencoinsmother's jewellerysafety pin / diaper pin·Adultsfish, meat bone / lump of meatdentures
Types of FB • Children coins mother’s jewellery safety pin / diaper pin • Adults fish, meat bone / lump of meat dentures
ClinicalfeaturesHistoryof FB ingestionDysphagiaDiscomfort/painTendernessovercricoidLongstanding FB -pain,fever,completedysphagia(abscessformation)Indirect laryngoscopy= pooling of saliva inpyriformfossa
Clinical features • History of FB ingestion • Dysphagia • Discomfort / pain • Tenderness over cricoid • Longstanding FB – pain, fever, complete dysphagia (abscess formation) • Indirect laryngoscopy – pooling of saliva in pyriform fossa
InvestigationsPlainX-raysofttissueof neck-AP&lateralviewsmeat bone,metallic FBs-radiopaquefishbones-usually notradiopaquemeat lump-widening of lumenGastrograffin /barium swallow -filling defectDiagnostic oesophagoscopy -flexible, rigid
Investigations • Plain X-ray soft tissue of neck – AP & lateral views meat bone, metallic FBs – radiopaque fish bones – usually not radiopaque meat lump – widening of lumen • Gastrograffin / barium swallow – filling defect • Diagnostic oesophagoscopy – flexible, rigid
Foreign Body IngestionRadiopaqueCoinsCartilage/bonesRadiolucentUndigestedmeat/chickenBariumswallow
Foreign Body Ingestion ◼ Radiopaque ◼ Coins ◼ Cartilage/bones ◼ Radiolucent Undigested meat/chicken ◼ Barium swallow
Foreign Body IngestionBariumSwallowTeddybeareyeinesophagusRadiolucent butbariumswallowwill outlineit
Foreign Body Ingestion ◼ Barium Swallow ◼ Teddy bear eye in esophagus ◼ Radiolucent but barium swallow will outline it