Flexible Bronchoscopy for Foreign Body Extraction

Young children can frequently aspirate a foreign body into their airways. This leads to problems like difficulty in breathing, whistling sounds or wheezing, stridor and collapse of a part of the lung. Foreign body aspiration is common in the age groups of 6 months to 3 years of age, because young children frequently put items into their mouth and their inability to completely chew due to absence of molar teeth.

The common foreign bodies seen are vegetable foreign bodies like peanut, cashew nut or kaju, almond or badam, walnut and betel nut/supari. Other non-edible material can be found inside the airway like small parts of toys, wrappers of biscuits, etc. Occasionally we also find sharp foreign bodies like screws, nails, thumb pins, scarf pins., etc. Foreign body aspiration sometimes can be life threatening and hence removal of foreign bodies is an emergency. Removal of foreign body is a skill and requires considerable experience.

What are the methods available to remove foreign bodies from the child’s airway?
Foreign bodies can be removed from the airways of a child by either doing a rigid bronchoscopy or a flexible bronchoscopy.

What are the advantages of using a flexible bronchoscopy for foreign body removal?
There are many advantages of using a flexible bronchoscopy over rigid bronchoscopy for removal of a foreign body. Flexible bronchoscopy can be done in the bronchoscopy room and does not require the child to be taken to the operation theatre. In addition, flexible bronchoscopy can be done under minimal amount of sedation and local anaesthesia and does not require a general anaesthesia as is the case with a rigid bronchoscopy. The additional advantages of the flexible bronchoscope is that it leads to minimal trauma to the child’s away. With a flexible bronchoscope we can reach up to the deeper parts of the airway and remove smaller foreign bodies which cannot be removed with the rigid bronchoscope.

Flexible bronchoscopy takes significantly less time to be arranged and performed. With a growing amount of experience flexible bronchoscopy has now become the modality of choice for removal of foreign bodies from the child’s airway.

How is a foreign body removed using a flexible bronchoscope?
A flexible bronchoscope is a flexible instrument which has a camera attached at the distal end. After the child is sedated and given local anaesthesia, the flexible bronchoscope is introduced through the nose of the child and gradually advanced to the voice box or the larynx and then into the windpipe or the trachea of the child. Thereafter a proper examination of the airways is done on both the sides. Once the foreign body is identified in the child’s airway, we pass a small basket through the channel of the bronchoscope. The basket is opened inside the airway and the foreign body is trapped inside the wires of the basket. Thereafter, the bronchoscope and the foreign body is removed. For removing sharp foreign bodies, different types of bronchoscopy forceps are used such as rat-tooth or alligator forceps.

Rigid Bronchoscopy for removal of foreign bodies from the child’s airway?
Occasionally a rigid bronchoscopy is required for removal of foreign body from the child's airway. These situations could be a foreign body which is stuck in the voice box or the larynx, a sharp foreign body, or a foreign body which is old and badly stuck. Rigid bronchoscopy is done in the operation theatre of the hospital and requires a general anaesthesia.

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