A Loose Screw: An Open Surgical Approach for Removing Large Laryngotracheal Foreign Bodies

Unusual airway foreign bodies have long interested airway specialists, and in the present case, the unusual feature is not the type of foreign body but its size. We describe the surgical management of a large, high-risk airway foreign body in a pediatric patient when an endoscopic approach is unsuccessful. A 22-month-old male aspirated a 3.5-inch drywall screw. The size of the screw in the airway of a patient of this age prompted a multidisciplinary approach to surgical removal, and we detail the preoperative, operative, and postoperative care of this patient, focusing on the surgical technique used and the coordination required among Pediatric Otolaryngology, Pediatric Surgery, and Pediatric Anesthesiology. Modern bronchoscopic techniques have made the removal of airway foreign bodies routine, but large airway foreign bodies remain a difficult challenge, and at times, an open technique is required. Traditional open surgical approaches, including thoracotomy, bronchotomy, and pulmonary resection, carry high rates of morbidity. Extended tracheostomy with cricoid split is a potential option for the removal of large laryngotracheal foreign bodies and merits consideration before proceeding to thoracotomy.