Tracheobronchial Foreign Bodies: An Updated Approach

Abstract

The foreign body spectrum was defined by Jackson and modernized since the turn of the century. In the past decade equipment advances have expanded the potential for successful endoscopic removal in centers other than metropolitan and university affiliates. Despite the aforementioned, morbidity statistics remain stable and early detection is declining. Reawakening diagnostic acumen and heightening public awareness are the keys to reversing this trend. Decreasing the 34% failure rate of plain films in the first 24 hours following inhalation of a foreign body will only be realized when fluoroscopy is universally accepted as an initial diagnostic technique in foreign body evaluation. A history compatible with foreign body aspiration dictates diagnostic endoscopy without radiologic confirmation. Lastly, a 24-hour interval is a safety zone which may be created in most instances. Only tracheal foreign bodies with associated intermittent dyspneic and/or cyanotic episodes need urgent removal. The safety zone assures adequate gastric emptying, the most qualified endoscopic team, and essential preparation regarding equipment. If the foreign body is not extracted, careful observation has been demonstrated in this study to be an attractive alternative. Vegetable foreign bodies including nuts have shown a potential for self extrusion. Physical therapy, corticosteroids and repeated endoscopy, when clinically indicated, can obviate the need for thoracotomy.