The charts of 143 patients with foreign bodies in the larynx and tracheobronchial tree who were admitted to the Chidrens Hospital of Los Angeles during the period 1973 to 1978 were reviewed. Of these children 84 were male and 59 were female. One hundred were private patients and forty-three were clinic patients. Of these foreign bodies 60 were nut meat which is by far the most common foreign body of the tracheobronchial tree. All foreign bodies were successfully removed. One hundred twenty-six were discharged within the first 24 hours after admission and treatment. Fifty-one or 36% of these patients were discharged on the same day after the foreign body was removed. Sixty-two of the foreign bodies were in the left bronchial tree, while 55 were in the right bronchial tree. One hundred thirty-eight were endoscoped under general anesthesia using the apneic technique and five patients were treated with oxygen standby only because of severe respiratory obstruction. A detailed description of the use of apneic technique with profound muscle relaxation, the avoidance of preoperative medication and the team approach to ventilating the patients are all described. The advantage of general anesthesia, and the potential intraoperative and postoperative problems are reviewed. Of the total number of cases 13% were between 4 and 11 months of age, 44% were between 12 and 23 months of age and 57% were over 23 months of age.

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One hundred and forty cases of papilloma of the larynx and tracheobronchial tree are documented in the records of the Childrens Hospital of Los Angeles. The records of 90 patients were available and were reviewed intensively. The method of direct laryngoscopy with general anesthesia using apneic technique in most patients and intubation in some was an adequate method of treating patients with laryngeal papillomata. A general anesthetic was never used where obstruction was severe and the airway could not be controlled. The low incidence of papilloma of the tracheobronchial tree and an absence of parenchymal lung seeding in this series is attributed to the avoidance of a tracheotomy and fewer intubation anesthetics thus avoiding trauma to the trachea and bronchi. The immediate removal of the tracheotomy tube seems as alternative if the surgical procedure had been performed. In the patients in this series decannulation was accomplished in a very short period of time. The establishment of an airway seem to be a priority in the treatment of this disease and this can be accomplished by repeated endoscopic procedures rather than tracheotomy. Statistics are given, and prognosis based on the type of lesion and histopathology is documented.