Morphometric Examination of The Tracheobronchial Tree in Cases with Foreign Body Aspiration

Year 2023, , 81 - 87, 28.02.2023

İnan Korkmaz , Mehmet Çelikkaya , Ahmet Atıcı , Alperen Kayalı , Mehmet Karadağ , Fatma Öz

https://doi.org/10.19127/mbsjohs.1197531

Abstract

Objective: Recently, few studies have evaluated bronchial morphometric parameters focusing on bronchial length, diameter, or angles. These parameters can be an important indicator in various pathological processes and are essential for simulating the flow of aspiration and inspired particle transport. The aim of this study is to determine the trachea, the diameters of the right and left main bronchus, the angle of the carina and the angulations of the right and left main bronchus; To investigate the extent to its affects the foreign body aspiration localization.

Methods: In this study, pediatric patients under the age of 18 who came with a history of foreign body aspiration and underwent computerized tomography between 2017 and 2020 were included in the study. The patients were evaluated in terms of age, gender, anatomical localization of the aspirated foreign body, diameter of trachea, right main bronchus, left main bronchus, carina angle, branching angles of right and left main bronchus on CT.

Results: Of the cases in this study, 13 (56.5%) were female and 10 (43.5%) were male, It was observed that the aspirated foreign body was on the left side in 12 (52.2%) children, and on the right side in 11 (47.8%) children. The mean age of the patients was 5.52±4.86. The right bronchial angle (RBA) mean of the children with the foreign body on the left side was 39.04 ± 6.68, with a significantly wider angle compared to the mean RBA in the children with the foreign body on the right side (p=0.013).

Conclusion: The factor affecting the localization of the foreign body is the branching angle of the right main bronchus. According to the results of our study, it has been observed that if this angle is less than 37, the object will be on the right side, and if it is 37 degrees and above, the object will turn to the left.

Keywords

Tracheobronchial tree, Foreign body aspiration, Carina angle

References

• 1. Zhijun C, Fugao Z, Niankai Z, Jingjing C. Therapeutic experience from 1428 patients with pediatric tracheobronchial foreign body. J Pediatr Sur 2008; 43:718-21.
• 2. Cevizci MN. Our Bronchoscopy Results in Suspected Tracheobronchial Foreign Body Aspiration Cases in Children. Balıkesir Medical Journal, 2020;4(1): 32-39
• 3. Mnejja M, Chakroun A, Bougacha L, Smaoui L, Ben Salah M, Chakroun A, et al. Bronchoscopy for foreign body inhalation in the pediatric population: lessons learned from 223 cases. Arch Pediatr 2012; 19:670-4.
• 4. Zerella JT, Dimler M, McGill LC, Pippus KJ. Foreign body aspiration in children: value of radiography and complications of bronchoscopy. J Pediatr Surg 1998; 33: 1651-1654.
• 5. Sauret V, Halson PM, Brown IW, Fleming JS, Bailey AG. Study of the three-dimensional geometry of the central conducting airways in man using computed tomographic (CT)images. J Anat 2000, 123–134.
• 6. Tawhai MH, Hunter P, Tschirren J, Reinhardt J, McLennan G, Hoffman EA. CT-based geometry analysis and finite element models of the human and ovine bronchial tree. J Appl Physiol 1997, 2310–2321.
• 7. Kamel KS, Lau G, Stringer MD. In Vivo and In Vitro morphometry of the human trachea. Clin Anat 2009; 22: 571-579.
• 8. Li Y, Li L, Zhou Z, Ren K, Lu H, Wang X, et al. Evaluation of the physiological changes in the central airway on multi-detector computed tomography. Respiration, 99(9), 771-778.
• 9. Olivier P, Hayon-Sonsino D, Convard JP, Laloë PA, Fischler M. Measurement of left mainstem bronchus using multiplane CT Reconstructions and relationship between patient characteristics or tracheal diameters and left bronchial diameters. Chest 2006; 130: 101-107.
• 10. Gamsu G, Webb WR. Computed tomograhy of trachea: normal and abnormal. AJR Am J Roentgenol 1982; 139: 321-326.
• 11. Kligerman S, Sharma A. Radiologic evaluation of the trachea. Seminars in thoracic and cardiovascular surgery 2009; 21(3): 246–254.
• 12. Ulusoy M, Uysal II, Kıvrak AS, Ozbek S, Karabulut AK, Paksoy Y, et al. Age and gender related changes in bronchial tree: a morphometric study with multidedector CT. European Review for Medical and Pharmacological Sciences. 2016; 20(16): 3351-3357.
• 13. Jit H, Jit I. Dimensions & shape of the trachea in the neonates, children & adults in northwest India. Indian Journal of Medical Research. 2000; 112: 27-33.
• 14. Chunder R, Nandi S, Guha R, Satyanarayana N. A morphometric study of human trachea and principal bronchi in different age groups in both sexes and its clinical implications. Nepal Med Coll J. 2010; 12(4): 207-214.
• 15. Farrukhabad UP, Chunder R. A morphometric study of human subcarinal angle in different age groups in both sexes and its clinical implications. Indian Journal of Basic and Applied Medical Research. 2015; 4(2): 424-430.
• 16. Coşkun ZK, Atalar K, Akar, B. Systematic literature study of trachea and bronchus morphology in children and adults. Folia morphologica (Warsz). 2022 Aug 24. doi: 10.5603/FM. a2022.0073. Epub ahead of print. PMID: 36000591.
• 17. Kubota Y, Toyoda Y, Nagata N, Kubota H, Sawada S, Murakawa M, et al. Tracheo-bronchial angles in infants and children. Anesthesiology. 1986; 64:374-376.