224 / 242
Resident Manual of Trauma to the Face, Head, and Neck
222
Chapter 10: Foreign Bodies and Caustic Ingestion
ii. Laryngoscope
Make sure an age-appropriate laryngoscope is also ready.
Iii. Forceps
Before bringing the patient into the operating room, select forceps
based on the location and type of foreign body. Optical forceps are
preferable, because of their visualization capabilities and manipulative
characteristics. However, optical forceps may impair ventilation,
because of their larger size, which incorporates the optical tract.
A Magill forceps and a Miller or Macintosh blade from the anesthesi-
ologist are often helpful for foreign bodies above the glottis.
c. Procedure
i. General anesthesia
Use general anesthesia to provide optimal airway control and patient
comfort.
ii. Esophageal Foreign Body
If an esophageal foreign body is suspected, intubate the patient for
airway protection, to prevent inadvertent aspiration during attempted
removal, and to minimize tracheal compression caused by the rigid
esophagoscope.
iii. Upper Airway Foreign Bodies
For upper airway foreign bodies, keep the patient spontaneously
breathing. Topically anesthetize the larynx with 1–4 percent lidocaine,
depending on the patient’s size and age, to inhibit laryngeal reflexes
and reduce the incidence of laryngospasm. Give preoxygenation and
maintain oxygenation by placing a catheter through the nares and into
the hypopharynx.
iv. Retrieval of the Foreign Body
During retrieval of the foreign body, remove the bronchoscope or
esophagoscope, forceps, and foreign body as a unit. Upon removal of
the foreign body, reexamine the airway or esophagus to look for a
second foreign body and to assess any potential damage.
Occasionally a foreign body is swallowed or aspirated during induction.
If a previously confirmed foreign body is no longer visualized, perform a
complete bronchoscopy and esophagoscopy.
3. Controversies in Management: Flexible versus Rigid Endoscopy
a. Rigid Endoscopy
Traditionally, rigid endoscopy is preferred for its ability to secure the
airway and provide control during the removal of foreign bodies. For this