Tracheobronchial anatomy and the distribution of inhaled foreign bodies in children
- 237 Downloads
Foreign body inhalation is a common and life-threatening emergency, and is most prevalent in young children. The traditional view is that tracheobronchial anatomy determines that an inhaled foreign body is more likely to enter the right main bronchus. This view has been challenged in young children, in whom the distribution of inhaled objects is more evenly distributed between the bronchi. We, therefore, investigated tracheobronchial anatomy relevant to foreign body inhalation in children.
Materials and methods
One hundred and fifty-six normal pediatric chest radiographs were selected from a large electronic database. Eight groups of radiographs were identified: supine (n=76) and erect; males (n=84) and females; aged <3 years (median age 12 [0.5–29] months) and ≥3 years (median age 126 [48–180] months). Tracheobronchial widths and angles were determined using a standardized technique with good reproducibility.
Overall, children had a proximal right main bronchus that was consistently steeper and slightly wider than the left (P<0.001), becoming more vertical in the erect position (P=0.0001). In most children, the carina was positioned to the left of the mid-trachea, but in 34% of cases (40% of infants), it was to the right of the mid-trachea. The effects of age and gender were otherwise minimal.
On the basis of tracheobronchial anatomy, an inhaled foreign body is more likely to enter the right bronchial tree than the left in children of all ages. However, the variability in the position of the carina with respect to the mid-trachea may explain why this right-sided preference is less marked in children compared to adults.
KeywordsForeign body Inhalation Aspiration Airway obstruction
We wish to thank Dr. Baran Tokar of the Eskisehir Osmangazi University Faculty of Medicine, Turkey, for kindly providing the supplementary data from his publication cited in Table 4.
- 4.Center for Disease Control and Prevention (CDC) (2002) Nonfatal choking-related episodes among children—United States, 2001. MMWR Morb Mortal Wkly Rep 51:945–958Google Scholar
- 8.Cotton RT, Rutter MJ (2006) Foreign body aspiration. In: Chernick V, Boat TF, Wilmott RW, Bush A (eds) Kendig’s disorders of the respiratory tract in children, 7th edn. Elsevier Saunders, Philadelphia, pp 610–615Google Scholar
- 12.Landsman IS, Werkhaven JA, Motoyama EK (2006) Anesthesia for pediatric otorhinolaryngologic surgery. In: Motoyama EK, Davis PJ (eds) Smith’s anesthesia for infants and children, 7th edn. Mosby Elsevier, Philadelphia, p 816Google Scholar
- 14.Moore KL, Dalley AF (2005) Clinically oriented anatomy, 5th edn. Lippincott, Williams & Wilkins, Philadelphia, p 126Google Scholar
- 16.Robinson MJ, Roberton DM (eds) (2003) Practical paediatrics, 5th edn. Churchill Livingstone, Edinburgh, pp 479 and 481Google Scholar
- 17.Standring S (ed) (2005) Gray’s anatomy: the anatomical basis of clinical practice, 39th edn. Elsevier/Churchill Livingstone, Philadelphia, pp 1075–1076Google Scholar