We reviewed the records of all patients admitted to Cardinal Glennon Children's Hospital for foreign object aspiration from 1980 to 1987. There were 11 true glottic bodies, which accounted for 12.1% of the 91 foreign bodies detected in the airways. A mortality rate of 45% (5 patients) and transient hypoxic encephalopathy in 27% (3 patients) indicate the often tragic outcome of obstruction in the pediatric larynx. Two distinct types of foreign bodies were responsible for laryngeal obstruction in these children. The first group consisted of bulky items, mostly food, and resulted in a more severe type of obstruction, with higher mortality and morbidity. The second group of objects were thin, laminar, triangular bodies, which tended to wedge unsuspectedly in the larynx, mimicking inflammatory diseases and requiring endoscopy for their removal. Hypothetical models are used to explain the physical phenomena that occur in foreign body obstruction in the two different groups. Recommendations for intervention are made based on the conclusions.
Tracheoesophageal compression by aortic arch anomalies is rare. Nevertheless, one must keep this entity in mind because it is associated with significant morbidity. Although it is generally agreed that the barium swallow shows when an abnormal vessel is compressing the esophagus, the literature disagrees on whether a bronchoscopy is needed in the evaluation of these patients. Not uncommonly the symptoms of airway obstruction persist after surgery resolves the anatomic defect. To provide a basis for postoperative comparison, we propose that all patients with suspected aortic arch anomalies undergo endoscopy just before their operation. A series of 26 cases of aortic arch anomalies affecting the airway, seen over a period of 29 years, is presented. A discussion of the clinical presentation, the diagnostic and bronchoscopic findings, and the results of surgical treatment are presented in addition to a brief embryologic and anatomic discussion. A case illustrating the value of preoperative and postoperative bronchoscopy is presented.
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