Upper aerodigestive tract foreign bodies (上呼吸消化道異物)

Oropharynx (口咽)

Fish bones may lodge in the tonsil or tongue base.

Clinical features:

The patient complains of pain on swallowing and points to the suprahyoid region. The bone may only be obvious on palpation: X-rays are unhelpful.

Management:

Removal under direct vision.

Hypopharynx/oesophagus (下咽/食管)

A bone or food bolus usually gets lodged at one of four sites:

• One piriform fossa
• The postcricoid region (15cm from the upper incisor)
• The level of the aortic arch (at 25cm)
• At the oesophago-gastric junction (40cm)

Clinical features:

Dysphagia may be total, the patient spitting out saliva and pointing to the suprasternal or retrosternal region. A soft tissue lateral X-ray of the neck may delineate a bone.

Management:

Endoscopic removal should be undertaken as soon as possible, to avoid airway oedema, soft tissue infection or oesophageal perforation.

Bronchus (支氣管)

Often a peanut in a young child.

Clinical features:

After an initial coughing fit there is often a latent period before respiratory distress becomes obvious. The chest X-ray may show collapse of the lung distally, if the obstruction is complete, or emphysema of the involved side if the obstruction acts as a one-way valve.

Management:

Bronchoscopic removal is mandatory.