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Sources: A Manual Of Peroral Endoscopy And Laryngeal Surgery

Bronchoscopy should be done in all cases of chronic

pulmonary abscess and bronchiectasis even though radiographic study

reveals no shadow of foreign body. The patient by assuming a posture

with the head lowered is urged to expel spontaneously all the pus

possible, before the bronchoscopy. The aspirating bronchoscope (Fig.

2, E) is often useful in cases where large amounts of secretion may be

anticipated. Granulations m
y require removal with forceps and

sponging. Disturbed granulations result in bleeding which further

hampers the operation; therefore, they should not be touched until

ready to apply the forceps, unless it is impossible to study the

presentation without disturbing them. For this reason secretions

hiding a foreign body should be removed with the aspirating tube (Fig.

9) rather than by swabbing or sponge-pumping, when the bronchoscopic

tube-mouth is close to the foreign body. It is inadvisable, however,

to insert a forceps into a mass of granulations to grope blindly for a

foreign body, with no knowledge of the presentation, the forceps

spaces, or the location of branch-bronchial orifices into which one

blade of the forceps may go. Dilatation of a stricture may be

necessary, and may be accomplished by the forms of bronchial dilators

shown in Fig. 25. The hollow type of dilator is to be used in cases in

which the foreign body is held in the stricture (Fig. 83). This

dilator may be pushed down over the stem of such an object as a tack,

and the stricture dilated without the risk of pushing the object

downward. It is only rarely, however, that the point of a tack is

free. Dense cicatricial tissue may require incision or excision.

Internal bronchotomy is doubtless, a very dangerous procedure,

though no fatalities have occurred in any of the three cases in the

Bronchoscopic Clinic. It is advisable only as a last resort.