Foreign Bodies in the Air and Food Passages
Margaret A. Kenna MD1
Charles D. Bluestone MD2
1 Assistant Professor of Surgery (Otolaryngology) and Pediatrics, Yale University School of Medicine, New Haven, CT.
2 Professor of Otolaryngology, Department of Otolaryngology, University of Pittsburgh School of Medicine; Director, Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh, One Children's Place, 3705 Fifth Ave at DeSoto St, Pittsburgh, PA 15213-3417
Foreign bodies of the aerodigestive tract have been recognized for centurles. Before the early 20th century, foreign body aspiration or ingestion often meant prolonged illness and death.1 Prior to the advent of modern endoscopy, bronchotomy was the primary method of laryngotracheo-bronchial foreign body removal, and blunt metallic hooks, wire nooses, esophageal forceps, and pieces of linen attached to a piece of whalebone were used to extract foreign bodies from the esophagus.2
Not surprisingly, Weist, in 1882 (as cited by Clerf2), reported a 27.4% death rate for patients undergoing bronchotomy v a 23.2% mortality for those who were not treated. In 1911, LeRoche (as cited by Clerf2) reported the use of a rigid esophagoscope for removal of sharp foreign objects. It was Chevalier Jackson, however, who developed and refined aerodigestive endoscopy. By 1936, he was able to report a decrease in mortality from foreign bodies from 24% to 2% and a 98% success rate for bronchoscopic removal.1
Although there have been marked changes in anesthesia, equipment, and endoscopic teaching since Jackson's time, his remarkable record of success has not been significantly improved upon. The mortality for all recent series is now well below 1%, mainly due to improved anesthesia, instrumentation, and medical therapy of the suppurative complications.
