The Head and Neck 1 15 



The Larynx and Trachea. 



FOBEIGN BODIES. 



Though common enough in the pharynx, lodgment of foreign 

 bodies in the larynx is an accident of great rarity. The extreme sen- 

 sitiveness of the larynx is responsible for this immunity, for if they 

 do not become firmly wedged they are expelled by reflex cough- 

 ing. Boumay treated a dog one week for sore throat, accom- 

 panied by symptoms of dysphagia, whistling and roaring, coughing, 

 and occasional vomiting. It succumbed to asphyxia. The necropsy 

 revealed the presence of a small pebble near the vocal cords which 

 completely obstructed the orifice. The tracheal mucosa was edem- 

 atous and covered with a fibrinous exudate in which the stone was 

 also embedded. 



Foreign bodies may also fall into the trachea, and this accident 

 has happened where the tracheotomy tube has been employed. 



As a rule, if an obstruction more or less completely blocks the 

 passage, death quickly follows, but insignificant bodies are often 

 tolerated. 



Symptoms and Diagnosis. Where complete obstruction exists, 

 symptoms of sudden suffocation develop. Where incomplete ob- 

 struction occurs, the symptoms are those of a subacute type of laryn- 

 gitis, with dyspnea, coughing, vomiting, and expression of anxiety. 

 There may or may not be spasm of the glottis. Differentiation in 

 the latter case lies between displaced polypi and laryngeal edema 

 occurring as a complication of laryngitis. 



Treatment. If asphyxia threatens, immediate tracheotomy is 

 indicated. The opening should be made close to the larynx. If the 

 body is located above immediate relief is obtained, but if the dyspnea 

 persists it is evidence that the body is lower down in the trachea. 

 In the latter case a second opening should be made as low down 

 as possible. The next step is to endeavor to dislodge the body. 

 If it is in the larynx an attempt should be made to extract it by 

 the mouth, but if this fails, to dislodge it by manipulating with the 

 finger through the opening in the trachea. If the object is lower 

 down, it may be necessary to employ forceps, when great care 

 should be exercised not to force it further into the lungs. When 

 bodies reach the latter position they are beyond surgical intervention. 



