Resident Manual of Trauma to the Face, Head and Neck

Chapter 10: Foreign Bodies and Caustic Ingestion

4. Abdomen Check for bowel sounds, tenderness to palpation, and rigidity. 5. Fiberoptic Exam In all patients, airway stability is the most important consideration. Lack of patient cooperation or intolerance of a fiberoptic exam may dislodge a foreign body in the upper aerodigestive tract and lead to aspiration with subsequent obstruction. If fiberoptic evaluation has the potential to turn a stable airway into an unstable airway, imaging and possible intraoperative evaluation should be considered. D. Imaging Radiographic studies may confirm or localize a suspected foreign body. In pediatric patients, 70–80 percent of airway foreign bodies are vegetable matter, most commonly a radiolucent peanut. The majority of pediatric esophageal foreign bodies are radiopaque coins, but most adolescent and adult esophageal foreign bodies are food boluses. Therefore, lack of radiographic findings does not rule out a potential foreign body in the setting of a convincing history and physical exam. 1. Aspiration a. Radiographs y y Posterior-anterior (PA) and lateral soft tissues of the neck should be obtained for all laryngeal and tracheal foreign bodies. y y PA and lateral chest x-ray should be performed if there is a suspected pulmonary foreign body. y y Hyperinflation found on inspiratory and expiratory chest films or atelectasis on inspiratory films can aid in the diagnosis of a radiolu- cent foreign body. In pediatric patients, failure of the dependent lung to collapse in lateral decubitus films suggests bronchial obstruction. Both sides are recommended for comparison. y y Fluoroscopic evaluation is of little benefit in initial diagnosis. Decreased diaphragmatic movement on the obstructed side is noted in about 50 percent of cases. Fluoroscopy may be more beneficial in extraction of a foreign body. Biplanar fluoroscopy may be used for retrieval of radiopaque foreign bodies in the lung periphery.

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Resident Manual of Trauma to the Face, Head, and Neck