ign body
are:
1. The chute-like effect of the plica cricopharyngeus.
2. The chute-like effect of other folds.
3. The lurking of the foreign body in the unexplored pyriform sinus.
4. The use of an esophagoscope of small diameter.
5. The obscuration of the intruder by secretion or food debris.
6. The obscuration of the intruder by its penetration of the
esophageal wall.
7. The obscuration of the intruder by inflammatory sequelae.

[FIG. 91.--Illustrating the hiding of a coin by the folding downward
of the plica cricopharyngeus. The muscular contraction throws the beak
of the esophagoscope upward while the interposed tissue prevents the
tactile appreciation of contact of the foreign body with the side of
the tube after the tip has passed over the foreign body. Other folds
may in rare instances act similarly in hiding a foreign body from
view. This overriding of a foreign body is apt to cause dangerous
dyspnea by compression of the party wall.]

_The esophageal speculum for the removal of foreign bodies_ is useful
when the object is not more than 2 cm. below the cricoid in a child,
and 3 cm. in the adult. The fold of the cricopharyngeus can be
repressed posteriorward by the forceps which are then in position to
grasp the object when it is found. The author's down-jaw forceps (Fig.
22) are very useful to reach down back of the cricopharyngeal fold,
because of the often small posterior forceps space. The speculum has
the disadvantage of not allowing deeper search should the foreign body
move downward. In infants, the child's size laryngoscope may be used
as an esophageal speculum. General anesthesia is not only unnecessary
but dangerous, because of the dyspnea created by the endoscopic tube.
Local anesthesia is unnecessary as well as dangerous in children; and
its application is likely to dislodge the foreign body unless used as
a troche. Forbes esophageal speculum is excellent.

MECHANICAL PROBLEMS OF ESOPHAGOSCOPIC REMOVAL OF FOREIGN BODIES

The bronchoscopic problems considered in the previous chapter should
be studied.

_The extraction of transfixed foreign bodies_ presents much the same
problem as those in the bronchi, though there is no limit here to the
distance an object may be pushed down to free the point. Thin, sharp
foreign bodies such as bones, dentures, pins, safety-pins, etcetera,
are often found to lie crosswise in the esophagus, and it is
imperative that one end be disengaged and the lon