Larger objects unable to pass through the larynx can be broken into pieces and removed. A tracheotomy can be performed to remove the object through the tracheostoma in situations where the object cannot pass through the larynx. At times, the object becomes embedded into the surrounding mucosa due to edema caused by the object or to multiple failed attempts at removal. In this situation, it is prudent to stop and to wait 48-72 hours to allow for the edema to subside for a repeat attempt at removal. Thoracotomy may be necessary when the object stays embedded after failed endoscopic attempts.
Sharp objects are extremely challenging for endoscopic removal.
The pointed end tends to engage in the mucosa, causing the object to tumble with the point trailing. Pointed objects tend to be bendable or breakable. The bronchoscope is placed into the airway, and using foreign body forceps, the pointed end of the object is disengaged from the mucosa, moved distally and then removed. Pin-bending forceps may be used in certain situations. Safety pin removal is uniquely challenging, with removal endoscopically by sheathing the pointed end into the endoscope and locking the keeper outside the endoscope.