Extraction of Dental Crowns from the Airway: A Multidisciplinary Approach

Surgical Emergencies in the ICU

Surgical emergencies are common in the critical care setting and require prompt diagnosis and management. Here, we discuss some of the surgical emergencies involving the gastrointestinal, hepatobiliary, and genitourinary sites. In addition, foreign body aspiration and necrotizing soft-tissue infections have been elaborated. Clinicians should be aware of the risk factors, keys examination findings, diagnostic modalities, and medical as well as surgical treatment options for these potentially fatal illnesses.

Aspiration of dental items: Case report with literature review and proposed management algorithm

The aim of this present study is to describe a case of a screwdriver implant aspiration removed with flexible bronchoscopy. This study reviewed the current literature and the authors also proposed an airway management algorithm in case of suspected foreign body aspiration during dental procedures. A review of English-language literature of aspiration of objects after clinical dental practice from 1984 to 2021 was performed. The bronchoscopy was the main method for dental items removal. A total of 57 cases from the literature were enrolled in this study. Aspiration of dental crown and prostheses (43.85%) followed by implant material (19.29%) and tooth (15.78%) were the main aspirated items. Prevention is the better way to avoid this type of complication. Early diagnosis facilitates the removal of foreign body and bronchoscopy is considered the treatment of choice for removal of foreign body aspiration. Also, regular professional training in basic life support is required.

Organic vs. Inorganic Tracheobronchial Airway Foreign Body Aspiration: Does Type/Duration Matter?

OBJECTIVE

We sought to determine the time course of clinical and histologic differences between aspirated inorganic and organic foreign bodies.

STUDY DESIGN

In-vivo.

METHODS

Twenty Sinclair miniature swine (Sus scrofa domesticus) were divided into two groups-inorganic or organic foreign bodies. Either an organic (peanut) or an inorganic (Lego) foreign body was placed within a bronchus and left for 3, 5, 7, 14 or 21 days. The airway was reassessed at the predetermined endpoint at which time endoscopic, gross, and histopathological findings were documented. Specimens were scored with a pathologic scoring system to assess injury severity from the foreign body.

RESULTS

Foreign bodies were successfully placed in all 20 swine. Two animals required early euthanasia due to respiratory compromise. The foreign body was identified grossly in eight (40%) animals. An additional three (15%) had microscopic evidence suggestive of a previous foreign body of an undetermined duration. There was no difference in injury severity between organic and inorganic foreign bodies. The 3-day group had injuries limited to the bronchial lining, whereas the longer duration groups had bronchial and adjacent lung parenchymal involvement. There was no difference in injury severity between days 5 and 21.

CONCLUSIONS

Airway foreign bodies initially cause bronchial damage. After 5 days, the foreign body causes lung parenchymal changes. There was no difference in airway lesion severity between organic and inorganic foreign bodies.

LEVEL OF EVIDENCE

N/A Laryngoscope, 131:490-495, 2021.

Sewing machine needle retrieval from distal airways using flexible bronchoscope under fluoroscopy

18-year-old lady was admitted through emergency department after she accidently aspirated a long sewing machine needle into her airways. Upon examination, she was anxious with normal vital signs and without any respiratory distress with SpO₂ of 98% on air. Systemic examination was normal except slightly reduced breath sounds intensity on right lower side of chest. Her chest radiograph revealed needle in right lower lobe but it was not visualized on bronchoscopic examination of airways up to sub segmental level. Using flexible bronchoscope under fluoroscope guidance, needle was retrieved successfully from posterior basal sub segment of right lower lobe utilizing alligator biopsy forceps, without any noticeable complication.

Swallowed and aspirated dental prostheses and instruments in clinical dental practice: a report of five cases and a proposed management algorithm

BACKGROUND

Accidental swallowing or aspiration of dental instruments and prostheses is a complication of dental procedures. Failure to manage these complications appropriately can lead to significant morbidity and possibly death.

CASE DESCRIPTION

The authors present three cases of accidental swallowing of dental instruments during procedures and two cases of aspiration, one during a procedure and one long after the procedure. Although three of these five cases of foreign-body aspiration or ingestion were caught early and the patients were referred for endoscopic retrieval, two patients experienced prolonged symptoms that affected their quality of life before intervention occurred. Practical Implications The authors reviewed the literature and propose an evidence-based algorithm for management of such complications. Adherence to the proposed algorithm may decrease morbidity and mortality and improve patient outcomes.

Flexible bronchoscopy with multiple modalities for foreign body removal in adults

OBJECTIVES

Aspiration of the lower airways due to foreign body is rare in adults. This study aimed to determine the outcome of patients who received flexible bronchoscopy with different modalities for foreign body removal in the lower airways.

PATIENTS AND METHODS

Between January 2003 and January 2014, 94 patients diagnosed with foreign body in the lower airways underwent flexible bronchoscopy with different modalities, which included forceps, loop, basket, knife, electromagnet, and cryotherapy. The clinical presentation, foreign body location and characteristics, and applications of flexible bronchoscopy were analyzed.

RESULTS

Forty (43%) patients had acute aspiration, which developed within one week of foreign body entry and 54 (57%) had chronic aspiration. The most common foreign bodies were teeth or bone. More patients with chronic aspiration than those with acute aspiration were referred from the out-patient clinic (48% vs. 28%), but more patients with acute aspiration were referred from the emergency room (35% vs. 6%) and intensive care unit (18% vs. 2%). Flexible bronchoscopy with different modalities was used to remove the foreign bodies (85/94, 90%). Electromagnet or cryotherapy was used in nine patients to eliminate the surrounding granulation tissue before foreign body removal. In the nine patients with failed flexible bronchoscopy, eight underwent rigid bronchoscopy instead and one had right lower lung lobectomy for lung abscess.

CONCLUSIONS

Flexible bronchoscopy with multiple modalities is effective for diagnosing and removing foreign bodies in the lower respiratory airways in adults, with a high success rate (90%) and no difference between acute and chronic aspirations.

Foreign body aspiration of a dental bridge in the left main stem bronchus

Aspiration of tracheobronchial foreign bodies is a life-threatening event that occurs mainly in children. Occurrence in adults is rare and usually has a subtle presentation as most adults are unaware of aspiration of any foreign material. Decreased levels of consciousness, sedation, and neuromuscular diseases are major risk factors for foreign body aspiration in adults. Prompt diagnosis and intervention through foreign body retrieval are critical to prevent significant morbidity and mortality. Retrieval procedure is risky, and sudden decompensation of the patient can occur anytime. We are presenting an adult who accidentally aspirated his dental prosthesis during sleep and underwent successful retrieval of the dental bridge using flexible bronchoscopy.

Accidental aspiration of dental crowns and retrieval

AIM

The aim of this article is to create awareness among the dental practitioners regarding the various accidents which can happen during a dental procedure and stress upon the preventive measures that can be taken to reduce the same.

BACKGROUND

This article presents a case of aspiration of dental crowns by the patient and its retrieval by coughing and preventive measures which can be taken to avoid such circumstances.

CASE DESCRIPTION

A patient reporting to private dental practice accidentally aspirated the two-unit prosthesis (crowns) in the right lung during cementation. He was immediately taken to the hospital, where chest radiographs and computed tomographic (CT) scan were done in order to locate the actual position of the prosthesis. Bronchoscopy was planned to retrieve the crowns but the patient had a bout of cough and the crowns came out. A chest radiograph was taken to confirm the absence of crowns.

CLINICAL SIGNIFICANCE

Taking adequate precautions while performing any dental procedure in supine position can decrease the occurrence of such incidents. Rigid bronchoscopy is the advised method of retrieval in case the crowns are not coughed out.

A feasible approach for extraction of dental prostheses from the airway by flexible bronchoscopy in concert with wire loop snares

Tracheobronchial foreign body (FB) aspiration is a common problem worldwide, and the aspired objects can be very difficult to remove. Bronchoscopic removal of airway FBs can be safely accomplished with both rigid as well as flexible bronchoscopes. It is well known that a rigid bronchoscope more easily removes large FBs located in the central bronchi. A wide variety of instruments, such as biopsy forceps, Fogarty balloon catheters, alligator forceps, or wire baskets, are commonly available for removal. Herein, we report the case of a 75-year-old man with an airway dental prosthesis, the shape and composition of which complicated its extraction from the nearly totally occluded left main bronchus, using biopsy forceps and wire baskets. We describe the successful extraction of the challenging FB with a flexible bronchoscope in concert with wire loop snares and the avoidance of rigid bronchoscopy or thoracotomy.

The role of fluoroscopy in the removal of tracheobronchial pin aspiration

In this study, we investigated the role of fluoroscopy in the bronchoscopic removal of aspirated pins. Of 373 patients who underwent bronchoscopy for presumed tracheobronchial foreign body aspiration, 56 pin aspiration cases were selected and divided into two groups according to whether fluoroscopic guidance was required (group I) or not (group II). The localisation of foreign bodies, mortality and morbidity ratios and the duration of the procedures were investigated. Pin aspiration percentage was 15. Pins were mostly located in peripheral airways in group I, and in central airways in group II (p < 0.05). The mean duration of the procedure was 42 +/- 30 min in group I and 17 +/- 13 min in group II (p < 0.01). There was no mortality. Morbidity percentage was 7 in group I and 12 in group II (p > 0.05). No thoracotomy was required in any cases. Fluoroscopic guidance is safe and carries no additional morbidity and mortality and can be used for pins in the tracheobronchial tree.