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Use of a urology stone basket for removal of subglottic foreign bodies
Author(s) -
Sobin Lindsay,
Roberson David,
Watters Karen
Publication year - 2017
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.26519
Subject(s) - content (measure theory) , foreign bodies , computer science , urology , medicine , surgery , mathematics , mathematical analysis
Pediatric airway obstruction secondary to a foreign body is a leading cause of death in children both worldwide and in the United States. Children who present to the emergency department for intervention have improved survival rates. The majority of foreign body aspiration events occur in children less than 3 years old, primarily due to their lack of molars, developmental proclivity for placing objects into their mouths, and immature swallow mechanisms. The narrow infant and toddler airway compounds these issues and can result in partial or complete airway obstruction. Children who have aspirated a foreign body often present in one of three stages: acute respiratory distress, during an asymptomatic interval, or in a delayed fashion due to complications from a chronic foreign body. A positive history, physical exam, or imaging study should prompt an investigation for an airway foreign body. One series reported 91.8% of patients had a history of coughing or choking either immediately preceding presentation or upon recollection after a foreign body was removed. Patients in acute airway distress should proceed immediately to the operating room for an emergency bronchoscopy. Peanuts are the most common foreign body, although complete airway obstruction is more often due to globular objects such as hot dogs, grapes, and candies. Rigid bronchoscopy remains the standard of care; however, there are some institutions that advocate for primary or adjunctive flexible bronchoscopy. Rigid bronchoscopy allows for ventilation and instrumentation simultaneously. Many instruments have been described including a range of optical graspers, balloon dilation, Fogarty catheter, and urology stone baskets. The latter techniques have been described in stable distal airway obstruction, but not in acute subglottic or tracheal obstruction. Under these circumstances, a wide variety of techniques must available to the otolaryngologist including tracheostomy. Communication with an experienced anesthesiologist is of the utmost importance.