title: Clinical features and management of aspiration of plastic pen caps.
abstract: OBJECTIVE
  To describe the clinical features of pen cap aspiration and removal techniques.
  
  
  METHODS
  We retrospectively reviewed all children with a history of inhaling a pen cap who were referred to the ENT department, at Beijing Children's Hospital, between Jan 2006 and Dec 2010. Methods Clinical data was recorded, including patients' common information, physical examination, radiologic data and final outcome.
  
  
  RESULTS
  Data from 44 children, with a median age of 8.7 years of age (35 months to 12 years) and a male-female ratio of 7.8:1 were analyzed. The time between inhalation and diagnosis with extraction of the foreign body ranged from several hours to 6 years, but 75% (33/44) were seen within one week. 89% (39/44) had pen caps removed by rigid bronchoscopy under general anesthesia. Reverse grasping forceps were used in 62% of the cases and ordinary forceps in 38% of the cases (24/15, p<0.05). In 2 cases, the pen caps were coughed up. In 2 cases the FB was removed via a tracheotomy and in 1 case by thoracotomy.
  
  
  CONCLUSIONS
  Pen caps are an unusual foreign body in the airway, occurring frequently in school age children. Rigid bronchoscopy under general anesthesia with reverse grasping forceps was the most favorable method for extraction of pen caps, but open surgical approaches should be available.
authors.affiliation: ENT Department, Beijing Children's Hospital, Capital Medical University, Beijing 100045, PR China.
authors.forename: Min
authors.initials: M
authors.lastname: Chen
authors.forename: Jie
authors.initials: J
authors.lastname: Zhang
authors.forename: Weiyi
authors.initials: W
authors.lastname: Liu
authors.forename: Jing
authors.initials: J
authors.lastname: Zhao
authors.forename: Bing
authors.initials: B
authors.lastname: Liu
authors.forename: Yamei
authors.initials: Y
authors.lastname: Zhang
mesh_terms: D001980:Bronchi; D001999:Bronchoscopy; D002648:Child; D002675:Child, Preschool; D005260:Female; D005547:Foreign Bodies / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D008297:Male; D053120:Respiratory Aspiration / Q000175:diagnosis* / Q000628:therapy*; D012189:Retrospective Studies; D013525:Surgical Instruments