Paediatric Bronchoscopy for Foreign Bodies
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2025-03-08
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Open Access Atlas of Otolaryngology, Head & Neck Operative Surgery
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University of Cape Town
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Abstract
This chapter only addresses management of foreign bodies in the airway from the laryngeal inlet down to and including the bronchi. Due to the cone shape of the paediatric cricoid cartilage, the subglottis is the narrowest part of the trachea in the paediatric patient (Figure 1). If an aspirated foreign body is small enough to pass beyond the subglottic area then the most likely site of impaction is in the main bronchi. The right main bronchus is more vertically aligned and therefore the most common location of a distally lodged foreign body. The decision whether a bronchoscopy is required is based on history, clinical examination and chest x-ray findings. If there is strong suspicion of a foreign body based on history, clinical findings and/or x-ray, then bronchoscopy should be performed. It is acceptable to have negative bronchoscopy findings, but unacceptable to miss a foreign body because bronchoscopy was omitted. X-ray findings can be conclusive in cases of radio-opaque foreign bodies, or subtle when dealing with radiolucent ones. In the latter case, findings may include hy-perinflation during air trapping, segmental consolidation or collapse (Figure 2).
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Reference:
Jonas, N. 2025. Paediatric Bronchoscopy for Foreign Bodies. In Open Access Atlas of Otolaryngology, Head & Neck Operative Surgery. J. Fagan, Ed.Cape Town, South Africa: University of Cape Town. 5. http://hdl.handle.net/11427/43558 .