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AERO-DIGESTIVE FOREIGN BODY & TRAUMA Dr. Ahmed Al Arfaj

AERO-DIGESTIVE FOREIGN BODY & TRAUMA Dr. Ahmed Al Arfaj. Trauma & Foreign Body II. FOREIGN BODIES IN MOUTH &PHARYNX. Trauma & Foreign Bodies II. Foreign Bodies in the Mouth and Pharynx. Small pointed F.B.

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AERO-DIGESTIVE FOREIGN BODY & TRAUMA Dr. Ahmed Al Arfaj

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  1. AERO-DIGESTIVE FOREIGN BODY & TRAUMA Dr. Ahmed Al Arfaj

  2. Trauma & ForeignBody II FOREIGN BODIES IN MOUTH &PHARYNX

  3. Trauma & ForeignBodies II Foreign Bodies in the Mouth and Pharynx Small pointed F.B. splinters of bone, fish bones, bristles from a toothbrush, needles, nails, bits of wood and glass, etc. Site of impaction - tonsil - the valleculla - the base of the tongue - lat. wall of the pharynx

  4. Trauma & ForeignBodies II Foreign Bodies in the Mouth and Pharynx Large F.B. bits of toys, flat bones, coins, buttons, large fish bones, bite of false teeth, etc. Site of impaction - the piriform sinus - hypopharynx

  5. Trauma & ForeignBody II

  6. Trauma & ForeignBody II Foreign Bodies in the Mouth and Pharynx Odynophagia or dysphagia Diagnosis: - history - radiography - endoscopy

  7. Trauma & ForeignBody II Treatment of Foreign Bodies in the Mouth and Pharynx In the upper pharynx  direct vision rigid pharyngolaryngoscopy

  8. Trauma & ForeignBody II NOTE Attempts to dislodge F.B. by eating foods is not justifiable. • May causes delay and allows complications to develop.

  9. Trauma & ForeignBody II ESOPHAGEAL FOREIGN BODIES Five Levels -Cricopharyngeal -Thoracic inlet -Aortic arch -Tracheal bifurcation -Gastroesoesophageal

  10. Trauma & ForeignBody II Esophageal Foreign Bodies Unintentionally: CHILDREN: (3years) coins, toys, etc. ADULTS : bones, glass splinters, fish bones, false teeth, nails, needles, or cutlery [e.g., prisoners]

  11. Trauma & ForeignBody II Oesophageal Foreign Body coin plastic star

  12. Trauma & ForeignBody II Oesophageal Foreign Body Symptoms • dysphagia, odynophagia • drooling - coughing - early mediastinitis : • pain between shoulder blades • & behind sternum

  13. Trauma & ForeignBody II Foreign body. Coin in the cervical esophagus

  14. Trauma & ForeignBody II Esophageal Foreign Body Pathogenesis - upper esophageal sphincter - necrosis  mediastinitis, pleuritis, or peritonitis - paraesophageal abscess - surgical emphysema

  15. Trauma & ForeignBody II Esophageal Foreign Body Diagnosis History: Inspection: swelling or subcut.emphysema Palpation: neck & supra clavicular fossae Radiographs: Radiopaque F.B., Mediastinal emphysema Gastrografin: Radiolucent F.B. Esophagoscopy

  16. Trauma & ForeignBody II Differential Diagnosis Esophageal Foreign Body - mucosal lesions - obstructive tumor NOTE if a FB is suspected, always check hypopharyx & esophagus endoscopically using flexible fiberscope

  17. Trauma & ForeignBody II Esophageal Foreign Body Treatment Rigid Esophagoscope. Cervical esophagotomy Thoracotomy Perforation [ suture] Paraesophagitis & abscess  Drainage

  18. Trauma & ForeignBody II Esophageal Foreign Body Course & Complications - no sequelae &mostly pass spontaneously. - pressure nec.  mediastinitis - radiographs: Gas emphysema - perforation [gastrografin] - stool analysis

  19. Trauma & ForeignBody II

  20. Trauma & ForeignBody II

  21. Trauma & ForeignBody II flesh bolus hair pin

  22. Trauma & ForeignBody II

  23. Trauma & ForeignBody II hair pin flesh bolus

  24. Trauma & ForeignBody II

  25. Trauma & ForeignBody II FOREIGN BODIESOF THE LARYNX

  26. Trauma & ForeignBody II Laryngeal Foreign Body Symptoms - attacks of coughing - stabbing pains • dysphagia • dysphonia - dyspnea in infant’s - asphyxia in large F.B. eggshell,10, choked,stridor, dyspnea>aphonia

  27. Trauma & ForeignBody II

  28. Trauma & ForeignBody II Laryngeal Foreign Body glass

  29. Trauma & ForeignBody II Laryngeal Foreign Body Pathogenesis common sharp-edged, Pointed or large F.B. F.B. aspiration: - sudden fright, laughing or absence of the sensory innervation of the larynx nut shell

  30. Trauma & ForeignBody II Laryngeal Foreign Body Treatment Heimlich Maneuver? Slapping the back with the patient’s head down? Manual removal? Removal by laryngoscopy Tracheostomy or laryngostomy (cricothyrotomy)

  31. Trauma & ForeignBody II

  32. Trauma & ForeignBody II FOREIGN BODIES IN THE TRACHEOBRONCHIAL TREE

  33. Trauma & ForeignBody II FOREIGN BODIES IN THE TRACHEOBRONCHIAL TREE ETIOLOGY Usually in infants and children (> 50% under 4 years of age) Male predominance (> 60%) Most FB’s are organic material (mostly food derivatives) Location: Mostly in the right side ( >60%)

  34. Trauma & ForeignBody II Tracheobronchial Foreign Body Peanuts, nails, coins, balls

  35. Trauma & ForeignBody II PATHOLOGY • Depends upon: nature, morphology and the position of the F.B. No obstruction: no immediate effect By pass valve obstruction: wheeze Expiratory check valve: obstructive emphysema Stop valve: atelectasis

  36. Trauma & ForeignBody II CLINICALPRESENTATION Choking, cough, gagging & cyanosis Caused by laryngeal reflexes Asymptomatic phase Due to fatigue of cough reflex Wheeze, intractable cough, persistent or recurrent chest infection. Due to emphysema, atelectasis or infection

  37. Trauma & ForeignBody II Tracheobronchial Foreign Body Symptoms - Episodes of coughing - dyspnea - cyanosis - pain - intermittent hoarseness - sudden death - symptom-free intervals metal joy

  38. Trauma & ForeignBody II RADIOLOGICAL FINDINGS Normal findings Obstructive emphysema Atelectasis Radio-opaque F. B. Pneumonia, pneumothorax etc.

  39. Trauma & ForeignBody II Tracheobronchial Foreign Body Size & Shape The Rt. main bronchus Type & duration: trachitis or bronchitis + edema, granulations, bleeding, resp. valvular stenosis, emphysema, atelectasis

  40. Trauma & ForeignBody II Tracheobronchial Foreign Body Differential Diagnosis - diphtheria - pseudocroup - laryngeal spasm - whooping cough - bronchial asthma - intraluminal tumors - pulmonary tuberculosis - pneumonia - laryngeal stenosis - tracheal stenosis (absent larynx movements)

  41. Trauma & ForeignBody II Tracheobronchial Foreign Body Treatment Endoscopy extracted Important: Suspicion of a tracheobronchial foreign body is an absolute indication for endoscopy

  42. Trauma & ForeignBody II TREATMENT To be initiated on clinical suspicion Bronchoscopy: in most cases Bronchotomy

  43. Trauma & ForeignBody II Esophageal Rupture and Perforation CAUSES: • iatrogenic instrumentation • (most common cause) • blunt and penetrating trauma • neoplasms • increased abdominal pressure

  44. Trauma & ForeignBody II Esophageal Rupture and Perforation VARIANTS: • Mallory Weiss Syndrome: incomplete tear of esophageal mucosa and laceration of submucosal arteries from increased abdominal pressure (emesis in alcoholics),; treatment: usually self limiting, • Boerhaave Syndrome: increased abdominal pressure results spontaneous rupture of all 3 layers of the esophagus (usually distal, posterior wall)

  45. Trauma & ForeignBody II Esophageal Rupture and Perforation SIGNS & SYMPTOMS: • chest pain - tachycardia • fever - respiratory distress • dysphagia - subcutaneous emphysema • Hammer’s sign (crunching sound over heart from subcutaneous emphysema)

  46. Trauma & ForeignBody II Esophageal Rupture and Perforation DIAGNOSIS: • clinical exam • chest x-ray mediastinal widening or pneumothorax • esophagogram (gastrogaffrin)

  47. Trauma & ForeignBody II

  48. Trauma & ForeignBody II Esophageal Rupture and Perforation COMPLICATIONS: • chemical mediastinitis • (saliva, bile, gastric acid) • septic shock.

  49. Trauma & ForeignBody II Esophageal Rupture and Perforation TREATMENTS: Early surgical repair and drainage (thoracotomy) may consider medical therapy (antibiotics and observation) for smaller perforation in select patients

  50. Trauma & ForeignBody II

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