FOREIGN BODY IN

TRACHEOBRONCHIAL TREE

dr. Ika Yuliartanti, SpTHT-KL

1
VARIETIES & INCIDENCE

2
ANATOMY

3
ANATOMY

4
BRONCHOSCOPIC APPEARANCE IN NORMAL
TRACHEOBRONCHIAL TREE

5
 BRONCHOSCOPIC APPEARANCE IN
NORMAL TRACHEOBRONCHIAL TREE

6
 ETIOLOGY

1. Personal factors (age, sex, occupation,

social condition, place of residence)
2. Failure of normal protective mechanism
 laryngeal closing reflex (sleep,
alcoholic incoordination, epileptic
seizure, unconciousness)
3. Physical factors, expression of
emotions, activities

7
 ETIOLOGY

4. Dental, medical, surgicl factors

5. Psychopathic & psychotic factors
6. Properties of foreign bodies
7. Carelessness

8
 SITE OF LODGMENT

• Right bronchus  more frequently

- Greater diameter
- lesser angle of deviation from tracheal
axis
- greater volume of air going into the right
bronchus on inspiration

9
 SYMPTOMS

• No symptoms at all  death by

asphyxia
• Initial symptoms:
- choking
- gagging
- coughing
- cyanosis

10
 SYMPTOMS
• Tracheal FB
- Pathognomonic symptoms
audible slap
asthmatoid wheeze
- Tracheal flutter
- Cough, hoarseness, dyspnea, cyanosis

11
 SYMPTOMS

• Bronchial FB
- coughing
- choking
- blood-streaked sputum
- metallic taste
- special odors of FB
- asthmatoid wheeze

12
 PHYSICAL SIGNS

• Depend on obstruction
• Limited expansion
• ↓ vocal fremitus
• Impaired percussion note
• Diminished intensity of breath sounds
distal to FB

Complete obstruction  drowned lung 

vocal resonance (-), vocal fremitus (-) 13
 ROENTGEN RAY
• Most valuable diagnostic aid
• Anteroposterior and lateral position
• Full inspiration and at the end of complete
expiration
High density: metallic FB
Less density: teeth, bones, shells, buttons
Non-radioopaque: plastic, rubber, food substances

• Sign of: obstructive emphysema and obstructive

atelectasis

14
15
 MANAGEMENT

• Larynx  direct laryngoscopy

• Tracheobronchial tree  perorally by
bronchoscopy

16
 BRONCHOSCOPY FOR
FOREIGN BODY

• INDICATIONS
- Every case of inspirated foreign body
in the lung, present or suspected.
- Any bronchial obstruction.

17
 Contraindications for
Bronchoscopy
• Absolute contraindications
– Absence of consent from the patient /
representative unless a medical emergency
exists and patient is not competent to give
permission
– Unstable cardiovascular, cardiac arrythmia
– Absence of an experienced bronchoscopist
– Lack of adequate facilities
– Inability to oxygenate the patient
– Coagulopathy, severe COPD, severe
refractory hypoxemia, unstable hemodynamic
status
18
 Contraindications for
Bronchoscopy
• Relative contraindications
– Partial tracheal obstruction
– Moderate hypoxemia
– pulmonary hypertension
– Debility, advanced age, malnutrition
– Respiratory failure
– Pregnancy (radiation exposure)

19
• Two main kind of bronchoscope:
1. Rigid 2. Flexible

20
21
 COMPLICATIONS

• Laryngeal edema
• Traumatic laryngitis
• Bronchospasm
• Postobstructive pulmonary edema

22
 COMPLICATIONS
Need surgical intervention
• Lung abscess
• Persistent granulation tissue
• Laryngotracheal or bronchial
stenosis
• Bronchial hemorrhage
• Pneumothorax
• Bronchial fistula
23
 COMPLICATIONS

• Fatal complications
- complete obstruction of the airway
- cardiac arrest induced by prolonged

hypoxia

24
 POSTOPERATIVE CARE

• Chest physiotherapy for retained

secretions
• Antibiotics

25
 POSTOPERATIVE CARE
– Steroids
• Not routinely used
• Traumatic insertion or removal
• Granulation tissue
• Higher incidence persistent pneumonia,
atelectasis
• Stridor and dyspnea ;
– dexamethasone 1-1,5 mg/kgbb up to 30 mg
bolus

26
 Thank you…

Thank you…

Thank you…

27