Management of Foreign Body Removal in Children by Flexible Bronchoscopy

Rigid bronchoscopy remains the gold standard in many countries to remove airway foreign bodies (FBs). We aimed to analyze the feasibility of airway FB removal in children, primarily by flexible bronchoscopy through a laryngeal mask.

Between 2008 and 2013, 62 children with suspected airway FB who underwent flexible bronchoscopy were analyzed in a retrospective chart review at a tertiary university hospital with respect to clinical presentation and medical management.

In 28/62 children (45.2%) an airway FB could be found and in all patients removed by flexible bronchoscopy. Additional 19/34 children (55.8%), in which no FB was found, showed macroscopic evidence of prior FB aspiration. The most frequently removed airway FBs were nuts (13/28; 46.4%) followed by other organic airway FBs (9/28; 32.2%) and nonorganic airway FBs (6/28; 21.4%). All FBs were uneventfully removed with a grasping forceps (16/28; 57.1%), basket forceps (9/28; 32.2%), suction (2/28; 7.1%), or polypectomy snare (1/28; 3.6%). Children with proven airway FB were significantly younger than children without an airway FB (24 vs. 27 mo). Adjuvant antibiotic therapy was given in 15/28 (53.6%) children with proven airway FB and 13/34 (38.2%) without, steroids in 24/28 (85.7%) and 21/34 (61.8%), respectively. In 6/28 (9.7%) children epinephrine intrabronchial was used to mobilize the airway FB during bronchoscopy.

In an optimized clinical setting, flexible bronchoscopy can be regarded as a feasible procedure to remove airway FB through a laryngeal mask. Short-term and long-term outcome is favorable.