1. Tracheal Foreign Bodies in Small Birds
Scott Ford, DVM, Dipl. ABVP-Avian
Association of Avian Veterinarians Conference
Providence, Rhode Island
August 6, 2007

3. Tracheal Foreign Bodies in Small Birds
Simple Problem!
…not always so simple to resolve…
…and something’s got to be done soon!
Goal of this talk is to present a practical option for a tough situation...
…not the only option for every tracheal obstruction

4. Overview Foreign bodies Other obstructive lesions Toys
Food (millet seeds)
Other obstructive lesions
Granulomas
Neoplasia
Strictures
Tracheal trauma

5. Medical Center for Birds Stats
7861 birds seen
890 cockatiels (11%)
13 birds <160 g body weight with tracheal obstructive symptoms (<1%)
5 of these had confirmed tracheal foreign bodies (4 cockatiels, 1 blue-crowned conure)
Used transtracheal technique on 4 of these w/100% success*

6. History / Presentation
Acute, severe dyspnea (tail pumping, wheezing, stretched neck)
Severe dyspnea 24 hrs after coughing episode
Millet in diet (don’t fixate)
Grossly audible congestion
Doesn’t resolve with mouth held open

7. Presentation

8. Priority 1: Establish Airway
With severe dyspnea, place in oxygen cage while discussing with owner and preparing for airsac cannulation
Gas anesthesia by mask
Install airsac cannula – standard technique

9. Establish Location, Nature of Obstruction
Tracheal Endoscopy
Size limitations
Cockatiel trachea requires <2 mm scope
Plain Radiography
Contrast Radiography
Wet neck with alcohol and transilluminate

10. Removal Options Suction Endosurgical retrieval Tracheotomy
Transtracheal

11. Transtracheal Technique
Advantages
Speed
Simplicity
Relatively atraumatic
May be possible in the absence of endoscopy
Limitations
Cannot reach caudal to the thoracic inlet
Neck incision, some tracheal trauma

12. Transtracheal Technique: Locating the Foreign Body

13. Transtracheal Technique: Locating the Foreign Body
Endoscopic inspection & transillumination

14. Transtracheal Technique: Locating the Foreign Body

15. Transillumination
Transilluminate using light cable (low setting), transilluminator, or penlight

16. Transtracheal Technique: Locating the Foreign Body

17. Transtracheal Technique: Exposing the Trachea
Consider lidocaine or bupivicaine block, 2 mg/kg diluted to 0.5%

18. Transtracheal Technique: Placing the Needle
Object is usually visible with trachea exposed.
Lateral View
Trachea

19. Transtracheal Technique: Placing the Needle

20. Transtracheal Technique: Dislodgement
Sterile syringe connected for forceful air injection

21. Transtracheal Technique: Placing the Needle
22G needle is introduced caudal to the obstruction

22. Transtracheal Technique: Dislodgement
Lateral View
Trachea

23. Transtracheal Technique: Dislodgement

24. Transtracheal Technique: Inspection
Leave needle in place
Brief upper endoscopic check to ensure all debris removed
Remove the needle, then…
Assess damage to trachea
Check all the way to the syrinx
If there are more items, remove them endoscopically or repeat the procedure
Culture, cytology, etc.

25. Transtracheal Technique: Completion
1-layer closure with absorbable suture
If trachea is confirmed clear, remove airsac cannula
If not, leave in place while treating, diagnosing further

26. Transtracheal Technique: Aftercare
Consider meloxicam or other NSAID
+/- oral antibiotics or antifungals, based upon cytology/cultures
Pain management may be appropriate (e.g., butorphanol)

27. Transtracheal Technique: Aftercare
Address other care issues
Follow-up calls and rechecks

28. Questions?

30. References
Macwhirter P. Malnutrition. In: Ritchie BW, Harrison GJ, Harrison LR, eds. Avian Medicine: Principles and Application. Lake Worth, FL: Wingers; 1994:
Hilllyer EV, Orosz S, Dorrestein GM. Respiratory System. In: Altman RB, Club SL, Dorrestein GM, Quesenberry K. Avian Medicine and Surgery. Philadelphia, PA: WB Saunders; 1997:
Quesenberry KE, Hillyer EV. Supportive Care and emergency Therapy. In: Ritchie BW, Harrison GJ, Harrison LR, eds. Avian Medicine: Principles and Application. Lake Worth, FL: Wingers; 1994:
Tully TN, Harrison GJ. Pneumonology. In: Ritchie BW, Harrison GJ, Harrison LR, eds. Avian Medicine: Principles and Application. Lake Worth, FL: Wingers; 1994:
Westerhof I. Treatment of Tracheal Obstruction in Psittacine Birds Using a Suction Technique: A Retrospective Study of 19 Birds. J Avian Med Surg. 1995;9(1):45-49.
Clayton LA, Ritzman TK. Endoscopic-Assisted Removal of a Tracheal Seed Foreign Body in Cockatiel (Nymphicus hollandicus). J Avian Med Surg. 2005;19(1):14-18.
Dennis PM, Bennett RA, Newell SM, Heard DJ. Diagnosis and Treatment of Tracheal Obstruction in a Cockatiel (Nymphicus hollandicus). J Avian Med Surg. 1999;13(4):
Altman RB. Soft Tissue Surgical Procedures. In: Altman RB, Club SL, Dorrestein GM, Quesenberry K. Avian Medicine and Surgery. Philadelphia, PA: WB Saunders; 1997:
Bennett RA, Harrison GJ. Soft Tissue Surgery. In: Ritchie BW, Harrison GJ, Harrison LR, eds. Avian Medicine: Principles and Application. Lake Worth, FL: Wingers; 1994: