AIR PASSAGES, Foreign Bodies in.
No time should be lost in removing any body lodged in the larynx through waiting for its exact location, by the X rays, owing to the danger of direct suffocation or the probable advent of reflex spasm. When time permits thoroughly cocainise the pharynx and larynx, then pass the index-finger into the throat, and if the substance is lodged about the entrance of the larynx it may be removed by forceps or fingers. Where the foreign body has entered the larynx, in the absence of spasm it may be removed by forceps guided through the aid of the laryngeal mirror. Where these attempts fail, laryttgo.fonty must be immediately performed when the symptoms are acute, and this can be readily accomplished with any cutting instrument at hand by making a vertical incision about r inch long in the middle line between the sterno-hyoid muscles, and a transverse incision through the crico-thyroid membrane, which can be easily felt through the skin; subhyoid pharyngotomy, thyrotomy, or tracheotomy may be performed.
When the impacted body cannot be extracted through the wound, it may be pushed up into the pharynx and removed through the mouth.
Where the foreign body has passed into the trachea or bronchi the first step is to try inversion, but this should never be done unless everything is in readiness for opening the trachea, as there is great danger of the body becoming lodged in the glottis and causing sudden death, and when this fails, as is generally the case, the surgeon should perform tracheotomy, making an unusually free incision through the tracheal walls, which should be held widely separate by hooks to facilitate the expulsion of the offend ing substance. This may be hastened by inverting the body and apply
ing a smart slap with the open hand between the shoulders.
When the foreign substance does not come through the tracheal wound or through the glottis, gentle efforts may be made to remove it by a loop of fine wire passed into the trachea, or by forceps. Should this fail, the tracheal wound must be kept open by silk threads passed through its edges and tied round the neck, when the surgeon can afford to wait a few days, since the opening in the trachea removes any immediate danger of suffocation. Afterwards forceps may be introduced through a Killian's tracheal tube passed into the tracheal wound.
In the hands of the specialist, the improved methods of suspension laryngoscopy with suitable tubes and forceps have revolutionised the older plans for locating and removing foreign bodies. Direct broncho scopy—by inserting a Killian's tube through the glottis—affords the safest and speediest method, when the object can be then grasped by Paterson's forceps.