[Reprinted from The Medical News, March 25, 1893.] 
A FOREIGN BODY IMPACTED IN THE LARYNX 
SEVENTEEN MONTHS; REMOVAL BY 
LARY NGO-TR ACHEOTOMY; 
RECOVERY. 
By J. F. KLINEDINST, M.D., 
EYE, EAR, AND THROAT SURGEON TO YORK HOSPITAL AND 
DISPENSARY, YORK, PA. 
L. H., thirty-nine years old, a farmer, on April 28, 
1891, while cutting down a tree, was struck upon the 
back of the neck by a heavy falling limb and thrown to 
the ground. Consciousness was lost. The man was 
immediately picked up by his companions, carried to 
the house, and a physician summoned. After a half- 
hour consciousness returned, but there was inability to 
speak and complaint of a sense of suffocation. Exami- 
nation of the mouth disclosed that an upper set of three 
artificial teeth, which the man had been wearing, was 
missing, and it was at once surmised he had swallowed 
it. His companions repaired to the place where he had 
fallen and there found the three artificial teeth, attached 
to a small piece of the broken plate, and, also, a part of 
the plate about the size of a pea. The greater part of 
the rubber plate was, however, missing. 
For nine days the man suffered inexpressible agony, 
gasping for breath, and spent most of this time sitting 
in a chair, not being able to lie down. At the expira- 
tion of this time, during a violent attack of coughing, 
with threatening suffocation, he expelled the larger part 
of the missing plate of rubber. (Fig. 1.) He now was 2 
greatly relieved, could breathe with more ease, and was 
able to sleep at night in the recumbent posture. Sleep 
was, however, not as sound as before the accident, for 
he was awakened at times by violent attacks of coughing 
and a sense of suffocation, which would gradually sub- 
side, when he could resume sleep. His voice, however, 
had not yet returned. What had become of the re- 
maining part of the rubber plate was a mystery. The 
patient was not conscious of the presence of a foreign 
body in his larynx. The loss of voice and the other 
Fig. i. 
symptoms of laryngeal irritation were attributed to the 
irritation resulting from the nine days’ sojourn of the 
piece of plate and its subsequent expulsion. From this 
time on the man’s health began to fail and his voice 
did not entirely return until several months later, and 
even then it remained husky up to the time of operation. 
Following the accident there had been a constant cough. 
In the fall of 1891, about six months after the accident, 
he had repeated chills and some fever; and soon he 
began to expectorate muco-purulent matter and to 
have night sweats; his breath also became offensive. 
In April, 1892, he expectorated some blood. These 
symptoms all seemed confirmatory of a diagnosis of 
tuberculosis, in which it was believed the larynx partici- 
pated. Some time later the man was presented by his 
physician to the Medico-Pathological Society of York 
County, when I first saw him. He was emaciated ; his 3 
complexion was sallow ; his expression anxious and dis- 
tressed. His breath was exceedingly offensive and of a 
grangrenous odor. A constant laryngeal cough was 
present, with muco-purulent expectoration. The tem- 
perature was slightly elevated and the pulse-beat accel- 
erated. A physical examination of the chest revealed 
only bronchial rales ; no cavities or consolidation in 
any part of either lung. The voice was husky and 
weak. A presumptive diagnosis of a foreign body in 
the larynx was made. On laryngoscopic examination 
Fig 2. 
Fig 3. 
the missing piece of plate was seen lying in the larynx 
in an antero-posterior direction, with its serrated edge 
upward and about one-eighth of an inch below the 
vocal bands. (Fig. 2.) An operation for its removal was 
advised and was performed in the presence of a number 
of physicians at the York Hospital, October 3, 1892. 
About half an hour before the operation the patient 
was given a hypodermatic injection of morphine and atro- 
pine, and was then anesthetized with chloroform. The 
skin over the larynx and trachea having been rendered 
aseptic, an incision was made through skin and fascia, 
from about the middle of the thyroid cartilage downward 
about two inches and a half. After all hepiorrhage was 
stopped an incision was made in the larynx through the 4 
crico thyroid membrane, cricoid cartilage, and down- 
ward through the first two rings of the trachea. The 
edges of the wound being retracted, an angular nasal 
polypus-forceps was introduced upward into the larynx 
and grasped the piece of plate, which, after a strong pull, 
could not be dislodged. The forceps was withdrawn 
and again introduced upward, but more nearly perpen- 
dicularly, and again grasped the piece of plate ; by giv- 
ing the forceps a slight turn to the right, I succeeded in 
dislodging and removing the foreign body. (Fig. 3.) A 
rubber canula was then introduced into the inferior por- 
tion of the opening in the trachea. The crico-thyroid 
membrane, cricoid cartilage, and trachea, above the 
canula, were united with carbolized catgut sutures, while 
the skin and fascia were united with silk sutures. The 
usual antiseptic dressings were applied around the 
canula. Over the mouth of the canula was kept a thin 
layer of moistened sublimate gauze through which the 
patient could breathe. 
During the time that the canula was in the trachea, 
the temperature of the room was kept at from 750 
to 8o°, and the atmosphere was charged with mois- 
ture from a kettle of boiling water. The object 
of having the temperature of the room so high and 
its atmosphere charged with moisture, was for the 
purpose of approximating the condition of the inspired 
air to that in which it would be if inspired through the 
nostrils. The patient’s temperature, seven hours after 
the operation, was 100.2°, falling to ioo° on the follow- 
ing day, and continuing thus for four days, when it 
began to gradually fall until the eighth day, when it 
reached 99.2°, where it remained until the patient was 
discharged. 
There was not much discharge from the canula 
or wound, except on the day following the oper- 
ation, when there was discharged from the canula some 
muco-pus, evidently from the situation in which the 5 
foreign body had been impacted. On the third day the 
canula was removed, and the opening in the trachea 
closed in three days by healthy granulations. The 
dressings were changed daily, and on the fourteenth 
day the patient was discharged from the hospital, with 
the upper portion of the wound entirely healed and the 
lower portion covered with a cicatrix. Upon his dis- 
charge the patient was greatly improved in appearance 
and color. Cough had ceased; the expectoration was 
changed in character; the offensiveness of the breath 
had disappeared ; and the voice had become more clear, 
although still husky and weak. Four weeks after his 
discharge from the hospital the improvement was still 
more marked. The man was Inuch stouter and had 
gained nineteen pounds in weight. 
There are several points of interest in this case. The 
first that attracts attention is the remarkable tolerance, 
by the larynx, of a foreign body so large as the one 
removed. Again, the extraction of such a foreign body 
by means of the laryngeal forceps would have been im- 
possible, because of its situation and the fact that it had 
become imbedded. The symptoms presented a striking 
resemblance to those of laryngeal tuberculosis, but a 
careful and thorough examination was sufficient to dis- 
prove such a diagnosis. Finally, the case demonstrates 
the point that when a foreign body is impacted below 
the rima glottidis the only safe and proper method of 
extraction is by tracheotomy or, preferably, laryngo- 
tracheotomy, which does not entail any serious injury 
upon the vocal apparatus.