Foreign Bodies in pharynx & oesophagus
FB in Pharynx • Common FBs fish bones, small sticks in food grain, steel wool • Most common sites tonsils, base of tongue, vallecula, pyriform fossa
Treatment • Tonsils – tongue depressor & forceps • Base of tongue – indirect laryngoscopy & angled forceps • Vallecula / pyriform fossa – hypopharyngoscopy under GA
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
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
Types of FB • Children coins mother’s jewellery safety pin / diaper pin • Adults fish, meat bone / lump of meat dentures
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
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 Ingestion ◼ Radiopaque ◼ Coins ◼ Cartilage/bones ◼ Radiolucent Undigested meat/chicken ◼ Barium swallow
Foreign Body Ingestion ◼ Barium Swallow ◼ Teddy bear eye in esophagus ◼ Radiolucent but barium swallow will outline it