Tracheobronchial foreign body aspiration in childhood. A report on 224 cases.

In 224 patients aged 7 months to 14 years aspirated foreign bodies (FB) were extracted from the tracheobronchial system. Eighty-one percent of the children were younger than 3 years, 50% were in the second year of life. There were twice as many boys as girls. Sixty-seven percent of the FB were nuts, of these more than half were peanuts. Fifty-six percent of aspirated FB were localized in the right bronchial system, 39% in the left and 5% subglottic or tracheal. All FB could be removed by endoscopy under general anaesthesia with muscle relaxation. The development of an extraction technique without forceps ("encasing") led to an easier way of removing crumbling FB, like nuts. Complications were rare, no postoperative tracheotomy was necessary, no cardiac arrest and no death occurred. The interval between aspiration and intervention was longer than 3 weeks in one-third of the cases; in some cases it was months or years with the consequence of chronic damage of the bronchial system or the lung. The possibilities of prevention appear to be limited; thus it is necessary to diminish the frequency of prolonged lodging of FB in the respiratory tract by considering aspiration early in the differential diagnosis of airway symptoms.