复旦大学：《耳鼻咽喉科学》课程教学资源（PPT课件讲稿，英文版）Aerodigestive Tract

Foreign Bodies Foreign body ingestion Foreign body aspiration a Toddlers Oral exploration Lack posterior dentition easy distractibility Cognitive development (edible?)

Foreign Bodies ◼ Foreign body ingestion ◼ Foreign body aspiration ◼ Toddlers ◼ Oral exploration ◼ Lack posterior dentition ◼ Easy distractibility ◼ Cognitive development (edible?)

Foreign body ingestion coins-75% Bones(mainly fish bone) Meat a Vegetable matter False teeth a Less than 24 hours in most

Foreign Body Ingestion ◼ Coins – 75% ◼ Bones (mainly fish bone) ◼ Meat ◼ Vegetable matter ◼ False teeth ◼ Less than 24 hours in most

Foreign body ingestion a Parental suspicion a Symptoms Choking, coughing, dysphagia, odynophagia a Physical exam Drooling, refuses p o, fussy child Respiratory compromise

Foreign Body Ingestion ◼ Parental suspicion ◼ Symptoms ◼ Choking, coughing, dysphagia, odynophagia ◼ Physical exam ◼ Drooling, refuses p.o., fussy child ◼ Respiratory compromise

Foreign body ingestion Common locations onsils Vallecula epiglottica Pyriform sinuses Cricopharyngeus Aorta/left mainstem bronchus Gastroesophageal junction

Foreign Body Ingestion ◼ Common locations ◼ Tonsils ◼ Vallecula epiglottica ◼ Pyriform sinuses ◼ Cricopharyngeus ◼ Aorta/left mainstem bronchus ◼ Gastroesophageal junction

Foreign body ingestion a Radiopaque coins Cartilage/bones Radiolucent Hot dogs Barium swallow

Foreign Body Ingestion ◼ Radiopaque ◼ Coins ◼ Cartilage/bones ◼ Radiolucent ◼ Hot dogs ◼ Barium swallow

Foreign Body Ingestion Barium swallow

Foreign Body Ingestion ◼ Barium Swallow

Foreign body ingestion Observation Recent ingestion Blunt object Endoscopy Complete obstruction Airway compromise Impacted Caustics Anomalies

Foreign Body Ingestion ◼ Observation ◼ Recent ingestion ◼ Blunt object ◼ Endoscopy ◼ Complete obstruction ◼ Airway compromise ◼ Impacted ◼ Caustics ◼ Anomalies

Foreign body ingestion Removal general anesthesia Intubated Esophagoscopy Examine for ulceration/perforation

Foreign Body Ingestion ◼ Removal ◼ General anesthesia ◼ Intubated ◼ Esophagoscopy ◼ Examine for ulceration/perforation

Foreign body ingestion Disc batteries Emergency NaOH, KOH, mercury 1 hour -mucosal damage 2 to 4 hours- muscular layers 8 to 12 hours- perforation Esophagoscopy Observation for gastric location for 4-7 days Laparotomy for bowel perforation

Foreign Body Ingestion ◼ Disc batteries ◼ Emergency ◼ NaOH, KOH, mercury ◼ 1 hour – mucosal damage ◼ 2 to 4 hours – muscular layers ◼ 8 to 12 hours – perforation ◼ Esophagoscopy ◼ Observation for gastric location for 4-7 days ◼ Laparotomy for bowel perforation

Foreign body ingestion Complication Perforation of esophagus Subcutaneous/mediastinal emphysema Mediastinal abscess Break of the aorta Esophageal fistula/ stricture

Foreign Body Ingestion ◼ Complication Perforation of esophagus Subcutaneous/mediastinal emphysema Mediastinal abscess Break of the aorta Esophageal fistula/stricture