Office Procedure For Management of Foreign Body: Cricopharynx

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The Internet Journal of Otorhinolaryngology

Volume 4 Number 2
Office Procedure For Management Of Foreign Body:

Cricopharynx
S Vaidya, R Pagare, V Sharma
Citation
S Vaidya, R Pagare, V Sharma. Office Procedure For Management Of Foreign Body: Cricopharynx. The Internet Journal of
Otorhinolaryngology. 2005 Volume 4 Number 2.
Abstract
Introduction: There are few reports of removal of impacted foreign bodies in the cricopharynx as office procedure. This is the
retrospective review of 114 consecutive patients of Foreign Body Cricopharynx reporting between years January 1992 to August
2005.
Set up: Tertiary Care (Medical College) Hospital.
Material, Methods And Results: Out of 114 patients with foreign bodies in cricopharynx (average age 7.6 years), we have
removed F Bs in 111 cases successfully in E.N.T. outdoors without early or late complications. The instruments used were
Macintosh laryngoscope and Laryngeal foreign body forceps. Three patients were subjected for Flexible Fibreoptic Endoscopy
of oesophagus, as F Bs had descended down during the course of treatment.
Conclusion: This study suggests that removal of FB in cricopharynx, as outdoor procedure, is both safe and cost effective.
This paper was presented in the First International

Conference of Rural Surgeons held in September 2005 at
UJJAIN (MP).
oesophageal junction (10%).(Figure: 1) Oesophageal F.B. is

urgent medical situation but not life threatening. 4,5.
Abbreviations
F.B. (Foreign body), F.B.s (Foreign bodies)
INTRODUCTION
Out of all the emergencies, reporting in ENT/ Paediatric
Surgery Department, foreign body impacted in upper GI
tract is most alarming and apprehensive. A common problem
in both adults and children, estimated annual incidence in
USA is 120 per million population. 1
This incidence is more in children than adults, more in male
child. About 1500 deaths are reported per year in USA. Less
than 1 % of F.B.s results in serious morbidity. 2
Various types of F.B. are impacted in G.I. tract. Most of
them are usually coins, less common are buttons, chocolate,
toffees, fishbone, and other food related F.B.s. 3, 6
Sites of impaction are mostly at cricopharynx (70%),
frequently at aortic arch indentation (20%) and rarely at
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Office Procedure For Management Of Foreign Body: Cricopharynx

Figure 1
Figure 2
Figure 1: Constrictions of Oesophagus
Figure 2: X-ray of Neck, Chest & Abdomen PA View.
MATERIAL AND METHODS

Total 114 consecutive paediatric cases of foreign bodies in
cricopharynx are included in this study, reporting at tertiary
care Hospital, between the year January 1992 to Aug. 2005.
Usual symptoms were history of ingestion of F.B., along
with dysphagia, odynophagia, and sensation of foreign body
in throat, excessive salivation, pain in neck, vomiting and/or
retrosternal pain.
Radiograph of neck, chest and abdomen (both P.A. and
lateral view) were considered essential to confirm the
diagnosis. (Figure 2 & 3 ).
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Figure 3
Figure 4
Figure 3: Lateral X-ray of Neck & Chest
Figure 4 : Instruments used in Laryngoscopy
Details of the patients including age, sex, accuracy of above

mentioned radiograph, method of Macintosh Laryngoscopy
under local anaesthesia, time required in the procedure, types
of the foreign bodies found, duration of the hospital stay and
complications were analysed and discussed below.
PROCEDURE
Foreign body was removed as office procedure under local
anaesthesia after taking written consent. Nil by mouth, prior
to the procedure was not required, as sedation or general
anaesthesia was not used. The patient was not admitted and
sent home after the procedure.
Foreign bodies other than cricopharynx were excluded from
the study. The instruments used were McIntosh
laryngoscope (used by anaesthesiologist for endotracheal
intubation) and laryngeal foreign body forceps. (Figure 4)
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Anaesthesia used was Xylocaine spray 4 %, 3 times at 5

minutes interval. Patient was kept on sterile sheet in The
Rose Position. The Child was wrapped in mummy drape to
prevent movement of the patient during the procedure.
Laryngoscopy examination was done by the Macintosh's
Laryngoscope. Laryngoscope was put in valleculae and
larynx was elevated. Palpating & grasping of F. B. was done
with the laryngeal foreign body removal forceps in
cricopharynx & upper end of oesophagus and F .B. was
removed. (Figures 5 & 6).

Figure 5
Figure 5: Laryngoscopic Examination
7.6 years, out of which 65 (57%) were males and 49 (43%)

were females The radiograph of neck, chest and abdomen
was found to be diagnostic in 98.24% of patients. Out of 114
cases, 111 (97.3%) Foreign bodies were taken out
successfully in the outdoor department immediately after the
wet films of the x-rays were received. In three patients, F.B.
could not be detected as they had descended down during the
procedure, which was confirmed later on by repeat X-rays
and removed by flexible fibreoptic endoscopy of
Oesophagus.
Actual time required in the procedure was less than one
minute in most of the cases. Janik & others have reported,
the removal of F.B.s in 45 seconds with the Magill forceps.
7.
Figure 6
TYPES OF F.B.S. removed are:
Figure 6: View on Laryngoscopy
Figure 7
Note :One child aged 11.5 years reported with partial

denture (approximate size 2.25 cms by 1.25 cms) impaction
at cricopharynx, which was removed successfully with this
procedure. The patient was using partial denture for
traumatic loss of lower incisor.
All patients were allowed to go home in about half hour after
the procedure. There were no immediate or late
complications noted with the procedure.
DISCUSSION
Sometimes, it was a blind procedure, because F.B. could not

be visualised but could be removed by palpating it with the
forceps.
RESULTS
Patients' age was between 1 to 12 years. Average age was
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The most popular technique of removal of foreign body

oesophagus is Rigid Oesophagoscopy. Other techniques
include Flexible Fibreoptic Oesophagoscopy, Foley Catheter
Technique, and Oesophageal Bougienage. 6 All these
methods required general anaesthesia. Authors have studied
a new way to manage foreign body impacted at upper end of
oesophagus i.e. cricopharynx by using Macintosh
laryngoscope under local anaesthesia .
A long stay in the hospital with Endoscopy of upper G I tract
was converted into minor outdoor procedure. As the
procedure relieved symptoms of foreign body impaction
immediately, general anaesthesia was not required in any of

our patients. There was no immediate or late complication
observed with the procedure.. Results were remarkably good
as there was no mortality or morbidity. It relieved anxiety of
relatives immediately as there was no time lag. It caused less
apprehension to the surgeon .It saved hospital stay, therefore
the cost of hospitalization was deducted. Overall cost of the
treatment was reduced, as the instruments are cheaper and
easily available. 8,9
Management protocol suggest for patients reporting with
History of foreign body ingestion is as follows:
Examination of oral cavity and oropharynx with
tongue depressor.
X-ray of neck, chest, and abdomen (both P.A and
lateral view) to determine the exact site of foreign
body.
Examination of patient with McIntosh
laryngoscope and removal of F.B under local
anaesthesia with laryngeal F.B forceps.
Fibreoptic flexible oesophagoscopy, when foreign
body has passed cricopharyngeal junction.
Watchful observation of stools. .10
CONCLUSION
The history of foreign body ingestion and radiograph of
neck, chest, and abdomen were found to be deciding factors
for a direct Laryngoscopy examination. Authors have found
Macintosh laryngoscopic examination under local anesthesia
as a method of choice for foreign bodies impacted at
cricopharyngeal junction. Safe, short, and cost effective
management under local anaesthesia and no complications
are advantages over the other conventional techniques.
5 of 6
ACKNOWLEDGMENT
Authors are greateful to Dr. V K. Mahadik, Medical
Director, R.D. Gardi Medical College & Ujjain Charitable
Trust Hospital Ujjain (MP) for giving us permission to
publish this research paper and for encouragement and
support.
CORRESPONDENCE TO
Dr. Sudhakar Vaidya, D.N.B. (ENT), D.L.O. Associate.
Professor Dept. of Otorhinolaryngology R D Gardi Medical
College & Ujjain Charitable Hospital D-3/2 ,Saupan
,Dhanvatari Nagar ,Near Birla Hosp. UJJAIN (MP), India
Email : drsvaidya@hotmail.com
References
1. Foreign bodies in upper gastrointestinal tract :Choudhary
A M: Journal of Kansas Medicine society :1987 88.:116
2. Foreign body ingestion in children:Monte C.
Uyemura:American Family physician digest:2005 july
3. Live fish in the throat :an Unusual F .B : Rohan
Walwekar, Haritosh Velankar , Pramod Shivalkar : Bombay
hospital journal: July 2003 Vol. 45 No. 3
4. Esophageal foreign bodies:Taylor R B :Emergency
Medicine Clinics of North America :1987;5:301-11
5. Management of ingested foreign bodies in
childhood:Spitz L :British Journal Medicine :1971;4:469-72
6. Foreign bodies of the oesophagus : two- year prospective
study: Abdulaziz A Ashoor ,Ali Al Mommen : Annals of
Saudi Medicine, Vol. 20,No 2,2000
7. Magill forceps extraction of upper esophageal coins: Janik
J E ,Janik J S : Journal Pediatric Surgery 2003
Feb;38(2)227.9
8. A safe and cost effective method of removal of obstructed
foreign body in the accident and emergency department :
Aneesh kumar ,S. Singh ,C. Low et al : European archives of
Otorhinolaryngology :Vol. 262 No.3, march 2005
9. The Removal Of Coins From Upper Esophageal Tract By
Emergency Physicians, A Pilot Study : Edward J.Vargas
,Ameer P. Mody, Tomy Y .Kim et al :Canadian journal of
emergency medicine , vol:.6 ,no:6, November 2004
10. A prospective study of foreign body ingestion in 311
children: Wai Pak M, Chung Lee W, Kwok Fung H. et al
:International Journal Pediatric Otorhinolaryngology .2001
April 6;58
Author Information
Sudhakar Vaidya
R D GARDI Medical college
R. S. Pagare
V. K. Sharma
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ISPUB.

The Internet Journal of Otorhinolaryngology

Office Procedure For Management Of Foreign Body:

This paper was presented in the First International

oesophageal junction (10%).(Figure: 1) Oesophageal F.B. is

Office Procedure For Management Of Foreign Body: Cricopharynx

Figure 1: Constrictions of Oesophagus

Figure 2: X-ray of Neck, Chest & Abdomen PA View.

MATERIAL AND METHODS

Office Procedure For Management Of Foreign Body: Cricopharynx

Figure 3: Lateral X-ray of Neck & Chest

Figure 4 : Instruments used in Laryngoscopy

Details of the patients including age, sex, accuracy of above

Anaesthesia used was Xylocaine spray 4 %, 3 times at 5

Office Procedure For Management Of Foreign Body: Cricopharynx

Figure 5: Laryngoscopic Examination

7.6 years, out of which 65 (57%) were males and 49 (43%)

TYPES OF F.B.S. removed are:

Figure 6: View on Laryngoscopy

Note :One child aged 11.5 years reported with partial

Sometimes, it was a blind procedure, because F.B. could not

The most popular technique of removal of foreign body

Office Procedure For Management Of Foreign Body: Cricopharynx

Office Procedure For Management Of Foreign Body: Cricopharynx

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