Tracheostomies in the Management of Aspirated Foreign Bodies in Children at the University Hospital Center of Dakar

Objective: To share our experience in the management of foreign body inhalation in children, describing our indications for tracheostomy and making a review of literature.
Design: Retrospective study.
Setting: Department of ORL and Head and Neck Surgery, University Hospital Center of Dakar, Senegal
Patients and Method: From 1997 to 2010, 232 children < 15 years were admitted to our ENT department with a diagnosis of aspirated foreign body, confirmed by bronchoscopy. Sixty three (63) children (population study size) underwent tracheostomies in the management of foreign body aspiration. Following data were recorded for each infant: age, sex, geographic origin, time from aspiration to hospital admission, foreign body aspiration syndrome and/or stridor, our indications of tracheostomies, endoscopic findings, decannulation delay, complications related to aspiration itself and to tracheostomy and the hospital stay.
Results: Among 232 cases of aspirated foreign bodies taken care of in our ENT department, rigid bronchoscopy removed objects from the larynx in 57 cases (24.5%), the trachea in 36 cases (15.5%) and bronchus in 139 cases (60%). The most common type of foreign body was organic (146 cases, 63%) and peanuts (81 cases, 35%) were predominent. Tracheostomies were performed in 63 cases (27%). Within this group (population study), the median age was 3 years ranged from 5 months to 12 years. The male female ratio was 1.4 (37 boys and 26 girls). Median time to admission was 10 days ranged from 24 hours to 4 months. Rigid bronchoscopy had located foreign bodies in the larynx in 29 cases (46%), in the trachea in 13 cases (21%) and in the bronchus in 21 cases (33%). According to the type of foreign bodies, there were food items in 47 cases (74%) and inorganic objects in 13 cases (21%). Indications of tracheostomies were stridor for 50 cases (86%), intubation in 4 cases (6%) and laryngeal edema in 9 cases (14%). Median decannulation delay was 7 days ranged from 1 day to 2 months. Median hospital stay was 26 days ranged from 1 day to 4 months. Complications of tracheostomies like tracheal stenosis and emphysema were present respectively in one. Complications related to foreign body like bilateral pneumothorax, recurrent pneumonia and bronchitis occurred respectively in one case. Open surgical retrieval of foreign body like bronchotomy was required in 2 cases. We regretted 8 cases of death, a rate of 3.5% in relation to all foreign bodies managed in the chart.
Conclusion: Foreign body aspiration is a life-threatening emergency. Early diagnosis and foreign body removal through bronchoscopy is required to avoid complications. In our conditions, tracheostomy had a critical place. We reported the highest rate of tracheostomies performed in the management of aspirated foreign bodies in the literature. The reduction of this rate could be a good mean to appreciate the improvement of management of foreign body aspiration in our countries.