Plastic laryngeal foreign bodies in children: A diagnostic challenge

Aspiration of foreign bodies that allow air passage through

“…Aspiration of a foreign body may result in immediate choking when lodged in larynx or may lead to complete obstruction of air entry into a lung segment [5,6]. Retained foreign body in the airway leads to local mechanical effects, chemical reactions and inflammation.…”

The simple bread tag – a menace to society?

“…In a retrospective study by Bloom et al [2] of 185 aspirated FBs, nine (5%) were found to be laryngeal. A laryngeal FB can either lodge at the glottic level or wedge in the subglottis.…”

“…Laryngeal FBs can be separated into two categories: large, conforming items that obstruct the laryngeal inlet causing immediate respiratory distress, and sharp, thin, aerodynamic FBs causing partial obstruction. [2] Partial laryngeal obstruction can cause variable and sometimes subtle symptoms mimicking other causes of upper airway obstruction. These symptoms include dysphonia, cough, stridor, wheeze and dyspnoea.…”

“…Additionally, thin laryngeal FBs are frequently radiolucent on a chest radiograph without the typical lung features of unilateral air trapping or mediastinal shift, making diagnosis with standard imaging difficult. [2] General practitioners and emergency room doctors need to have a high index of suspicion in the face of a nonspecific history and a normal plain radiograph.…”

“…These features also contribute to plastic FBs being missed on flexible nasopharyngo scopy and direct laryngoscopy. [2] The majority (80 -90%) of inhaled FBs occlude the bronchi, while the larynx is a less common site. [2] Three children presented at Tygerberg Children's Hospital, Cape Town, South Africa, between January 2011 and June 2012 with an unusual yet ubiquitous plastic laryngeal FB: the common bread tag.…”