(290) Laryngeal Foreign Body Retrieval in Setting of Limited Cervical Mobility

Introduction: A laryngeal foreign body (FB) can be life-threatening. Management includes its retrieval via laryngoscopy while maintaining adequate ventilation. We present a patient with a partial obstruction who was unable to undergo laryngoscopy for FB retrieval due to limited cervical mobility secondary to ankylosing spondylitis (AS). The FB was removed by placing the patient prone and delivering controlled blows to the back.

Methods: A 68 year old male with AS presented to the emergency department (ED) complaining of food in his throat. He had no signs of respiratory distress. Upper endoscopy by GI showed a food bolus in the posterior oropharynx which could not be removed due to aspiration risk. ENT was consulted and fiberoptic exam showed a FB sitting in the supraglottic larynx that was not fixed but partially occlusive. He later developed increased work of breathing and garbled voice. Vitals remained stable. FB removal in a controlled operating room (OR) was determined the best course.

Results: The patient was taken to the OR for video laryngoscopy and removal of FB with possible tracheostomy. Due to advanced AS, he could not move his neck away from the neutral position. Thus, the airway was unable to be secured via intubation and laryngoscopy instrumentation was limited. While moving the patient to the table, he was placed prone with his head hanging off of the side. Firm, controlled back blows were administered. The FB was dislodged and fell to the floor. His breathing improved. Repeat fiberoptic exam showed no FB in the larynx, subglottis, trachea, or carina. A chest x-ray the next day showed no acute cardiopulmonary changes.

Conclusions: We present this case as an example of a non-invasive option to remove a FB in a patient with limited neck mobility who cannot undergo laryngoscopy. By placing the patient in this position, we used gravity to safely flex his neck, creating a downward vector for the FB to follow when leaving the larynx. We also considered placing him prone in trendelenburg for a similar downward vector. We were prepared for alternate means of ventilation (emergency tracheotomy) if the initial plan to remove the FB was unsuccessful.