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8. Li ZP. Therapeutic coagulation induced in cavernous haemangioma

by use of percutaneous copper needles. Plast Reconstruct Surg

1992;89:613–22.

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cavernous haemangiomas. Acta Radiologica 1962;1:257–74.

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haemangioma arising from the parotid gland. Otolaryngol Head Neck

Surg 1991;104:858–62.

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Cavernous haemangioma of the parapharyngeal space

Intramuscular haemangioma of head and neck. J Otolaryngol Head Neck

Surg 1993;108:18–26.

14. Waner M, Sven JY, Dinehart S. Treatment of haemangiomas of the

head and neck. Laryngoscope 1992;102:1123–34.

15. Watson WL, McCarthy MD. Blood and lymph vessel tumours – A report

of 1,056 cases. Surg Gynecol Obstet 1940;171:569–88.

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neck haemangiomas and vascular malformations: review of 23 patients.

J Ultrasound Med 1997;16:39–44.

Address for CorrespondanceMr. U. S. Kale77, Christchurch Close EdgbastonBirmingham, UK, B15 3NE,

ABSTRACT: Tracheobronchial foreign bodies can be sometimes very difficult to remove. This may berelated to the location and type of foreign body, experience of the bronchoscopist and the availability of

appropriate instruments.[1] We report a case of an uncommon foreign body (artificial denture) in the

trachea in an adult female following extubation after Lower Segment Caesarian Section (LSCS) in whomconventional methods to remove it failed. The foreign body was eventually removed via tracheostomeusing rigid bronchoscope and forceps.

Key Words: Tracheostomy, foreign body, and denture

REMOVAL OF FOREIGN BODY FROM THE TRACHEA:AN UNUSUAL METHOD

Masood Ahmad, Shafkat Ahmad, Rouf Ahmad, Mohd. Lateef, Showkat Ahmad

Department of Otorhinolaryngology and Head and Neck Surgery, Govt. Medical College Srinagar-Kashmir, India

INTRODUCTIONInhalation of foreign objects is most common in childrenunder 3 years and is very rare in adults.[2,3] The larynx performsa very efficient sphincteric function to protect the lowerrespiratory tract and it is unusual for a foreign body to beinhaled as opposed to being swallowed especially in adults.[4]

A foreign body which impacts in the larynx may stimulatespasm and cause complete respiratory obstruction resultingin rapidly fatal outcome. Fortunately most aspirated objectspass into the bronchi.[4]

CASE REPORTA 25 year old female, primigravida underwent LSCS at LalaDed Hospital of Govt. Medical College Srinagar under

general anaesthesia. After extubation, patient did not maintainoxygen saturation and later developed biphasic stridor. Shewas initially managed conservatively but did not respond.Antero-posterior view of the X-ray chest and neck was advisedwhich was normal [Figure 1]. ENT consultation was soughtwhich revealed missing of an upper medial incisor tooth.Emergency rigid bronchoscopy was done which revealed apiece of pink-cartilage like material in the trachea resting oncarina with its long axis vertical and root upwards. Larynxwas edematous. The object was grasped with the alligatorforceps but could not be taken out through larynx because ofedema and irregular shape of the foreign body. Shear alsocould not be used because of the size of bronchoscope.Tracheostomy was performed and foreign body visualized via

Indian Journal of Otolaryngology and Head and Neck Surgery Vol. 58, No. 1, January-March 2006

81Removal of foreign body from the trachea

rigid bronchoscope, which was passed through tracheostome.Subsequently foreign body was grasped with forceps andremoved along with the bronchoscope. The foreign body wasthe artificial denture [Figure 2] which the patient hasconcealed. After three days, examination of the larynx showedsome residual congestion and edema of an otherwise normallarynx. The tracheostomy tube was removed and the openingwas allowed to heal. Subsequently patient made an uneventfulrecovery.

DISCUSSIONIt is usually possible to diagnose the presence of a foreignbody in the trachea in the acute phase of entry because ofreadily available history of intake and signs and symptomsreferable to the foreign body in the highly sensitive airpassage.[5] This may not be so, however, in an unconsciouspatient. The case reported here presented a puzzlingemergency. Apart from the missing incisor, it was notsuspected that she had been wearing an artificial denture. It isnot known at what stage the denture was inhaled. Since itwas a well fitted denture, it is probable that the combinationof severe jolt, rough suction and a sharply indrawn breathwould have impacted the foreign body in the trachea.

It is remarkable that the patient did not have severe respiratorydistress despite the presence of a large foreign body in thetrachea. This confirms the observation of Chevaller Jackson(1936)[6] that a foreign body may lodge in the antero-posteriorposition without causing much respiratory distress. The

Figure 2: Denture removed from the trachea

Figure 1: Antero-posterior view of the X-ray chest and neck whih did notshow any abnormal finding

development of stridor in this case indicates that the denturewas disturbed by repeated suction, which also resulted inincreased edema of the larynx. The degree of edema andsubmucosal hemorrhages were in themselves sufficientjustification for tracheostomy which allowed easy removalof the foreign body and could well save the sudden completeclosure of the airway which sometimes characterizes glotticclosure.

The episode does provide a reminder, however, that in allpatients who had to undergo surgery history of artificialdenture should be sought and appropriate precautions takenand that where airway problems are found with extubation,the possibility of a foreign should always be born in mind.

REFERENCES1. Umapathy N, Panesar J, Whitehead BT, Taylor JF. Removal of a foreign

body from the bronchial tree–A new method. J Laryngol Otol

1999;113:851–3.

2. Amari FF, Fans KT, Mahafza TM. Inhalation of wild barley into the

airway. Saudi Med J 2000;21:468–70.

3. Antoni JM, Samuel MR, Raul LT Jr, Giesela F. Clin Pediatr 1997;701–

5.

4. Sekent MG, Watson. Laryngeal foreign bodies. J Laryngol Otol

1990;104:131–3.

5. Mehta RM, Pathak PN. A foreign body in the larynx. Br J Anesth

1973;45:785–6.

6. Jackson LC. Endoscopy of foreign body. Review of 178 cases of foreign

body in the air and food passages. Ann Otol 1936;45:644.

Address for CorrespondanceDr. Masood AhmadDepartment of Otorhinolaryngology andHead and Neck Surgery, Govt. Medical CollegeSrinagar-Kashmir,India