Objective: To exhibit an innovative method to remove subglottic metallic foreign body without vocal cord damge through the endotracheal tube.
Method: A retrospective review of a challenging impacted subglottic metallic foreign body removal is presented as a case report.
Results: A 12-year-old male with autism spectrum disorder visited emergency department after 5 days of stridor and subjective dyspnea. The computed tomography scan showed 2.0 cm sized metallic foreign body, presumably a paperclip, in the trachea at C5-C6 level, without any definite evidence of upper airway tract perforation. Under general anesthesia, high-flow nasal cannula (flow 60L/min, FiO2 1.0) was connected to the patient, then suspension laryngoscopy was done. Pointed portion of the metallic foreign body was impacted to the tissue right distal to glottis, therefore direct removal was impossible. Then, after placing rigid bronchoscope between glottis and the foreign body, foreign body removal via bronchoscope lumen was tried, but the diameter was not large enough for the foreign body to pass. Then endotracheal tube (ID 7.5mm), which was relatively larger for the patient’s age, was intubated by the surgeon, then with optical forceps, the foreign body was pulled into the endotracheal tube. With careful advancement of the endotracheal tube, the foreign body was finally successfully placed into the tube lumen. Then the endotracheal tube and the foreign body were removed together.
Conclusion: An innovative way to remove impacted foreign body distal to the vocal folds, utilizing endotracheal tube without tracheostomy, is demonstrated in this case report.