Tracheobronchial foreign body aspiration: dental prosthesis

Risk factors and prevention of choking

Choking (or foreign body airway obstruction) is a widespread phenomenon with serious consequences of morbidity and mortality. Choking (often also called suffocation) can be caused by food or inedible objects and leads to various degrees of asphyxiation or lack of oxygen in the blood stream. The incidence is very high in both young children and adults, especially seniors. However, since not all choking episodes end up in the emergency room or become fatalities, they often escape statistics. Although episodes of choking from non-edible bodies are infrequent, they affect mostly young children. Three of the most common risks for choking in general are neurological disorders, dysphagia and dental issues (few or no teeth, unstable or unsuitable prosthesis or orthodontic appliances).  The purpose of this study was to evaluate the risk factors of choking and ways to reduce/avoid this event. We reported data on a series of 138 patients admitted to the emergency department following a choking event, at a hospital in Rome, Italy. The age group of the analyzed population ranged from 1 to 88 years, with the most represented age group of these between 40 and 59, with a similar distribution between males and females. The types of foods on which people choked reflected the seasonal, traditional and local foods: 67% of patients reported choking on fish bones followed by meat bones (9%)  and artichokes (3%). Three relevant non-food choking elements reported were: orthodontic items, toothpicks and pins (one occurrence each). We also reported on two clinical cases of patients choking on meat and a chicken bone. In conclusion, choking awareness and prevention are essential for implementing potential life-saving precautions. Prevention is the first tool to reduce the occurrence of this event, therefore it is necessary to analyze the risk factors and educate the population to eliminate them. Proper chewing and oral manipulation are paramount functions in preventing choking, along with meal-time supervision if little children and elderly. Then, it behooves the healthcare professionals to disseminate knowledge.

Different Modalities Used in the Art of Managing Tracheobronchial Foreign Bodies

Introduction:

Foreign body aspiration is a commonly encountered and challenging emergency. Foreign body aspiration causes significant morbidity and mortality in the paediatric population. In adults, it is usually encountered in patients with impaired consciousness and in young females using pins to secure their veils. We aimed to analyse the incidence, type and site of foreign body, radiological presentation, complications and different modalities used in managing tracheobronchial foreign bodies (FBs).

Methods:

A prospective single centre cross-sectional study between December 2010 and December 2011 in the Department of Cardiothoracic Surgery at the University of Alexandria, Egypt.

Results:

Seventy-eight patients were included. The age of the patients ranged between 1.3 and 32 years, with a mean of 13.37± 7.67 years. Inorganic FBs were the most common aspirated FBs (66 patients, 84.62%). FBs were more frequently located in the left versus the right bronchial tree (44.9% vs. 43.6%). Rigid bronchoscopic extraction of foreign bodies was the most common modality of extraction and was seen in 60 patients (76.9%), followed by thoracotomy and postural drainage in eight patients each (10.3%). Complications were observed in 12 patients (15.4%). Most of the patients who presented with pin aspiration were teenagers (> 10 – 20 years) and adults (> 20 years). At the same time, nut aspiration was common in children below 10 years.

Conclusion:

The location of FBs in the tracheobronchial tree depends on the patient's age and physical position at the time of aspiration. Rigid bronchoscopy offers better manipulations inside a secured airway and is the preferred method for foreign body removal. If failed, then surgical extraction should be done as soon as possible.

Aspirated Denture: A Rare Cause of Empyema in an Asian Male

Here, we report the case of an undiagnosed foreign body aspiration (FBA) in a 50-year-old male who presented with fever, productive cough, and shortness of breath suggestive of pneumonia. The patient reported a history of empyema for which he underwent left-sided video-assisted thoracoscopic surgery and decortication at another facility. Careful evaluation of prior chest imaging revealed a radio-opaque linear density projecting along the left of his spine suspicious for a foreign body in the airway which was missed on radiographic evaluation at the time of empyema. On flexible fiberoptic bronchoscopy, an irretrievable foreign body was visualized in the patient's left mainstem bronchus, which was removed via rigid bronchoscopy. This is a rare case of an aspirated denture manifesting as empyema and subsequently as pneumonia. We suggest that in patients with a recurrent chest infection, the possibility of FBA must be ruled out by detailed history and careful evaluation of imaging.

Accidental aspiration of removable dental prosthesis in a patient with Creutzfeldt-Jacob disease

Accidents involving dental prostheses are unusual but relevant, which may result in complications in the upper respiratory airways and esophagus. A 47-year-old male patient with Creutzfeldt-Jacob disease (CJD), completely dependent on care, was reported by his family to have a partial obstruction and intraoral bleeding after swallowing his upper Removable Partial Denture (RPD). After difficulties in the endoscopy procedure, a surgical approach by exploratory cervicotomy to remove the prosthetic device was conducted, without postoperative complications. Considering individual impairments and the patients' advanced age, the removal of dental prostheses during sleep or for patients under intensive care is a preventive strategy to reduce comorbidities in patients with unstable health conditions.

Dental prosthesis aspiration: An uncommon cause of respiratory distress

We present a case of a 66-year-old Caucasian man with acute respiratory distress. The patient had a history of multiple cerebrovascular accidents which resulted in left hemiplegia, swallowing problems, and aphasia. He was tentatively diagnosed with aspiration pneumonia. However, because of clinical deterioration further investigations concluded to the aspiration of a dental prosthesis. After intubation and stabilization, the prosthesis could be manually extracted. However, the patient developed a Staphylococcus epidermidis sepsis and despite adequate antibiotic therapy, he eventually died. Dental prosthesis aspiration is a medical situation associated with a higher morbidity and mortality rate compared to ingested foreign bodies. It requires a high level of suspicion to ensure a timely diagnosis and life-saving treatment. Thorough history taking is of great importance in case of tracheobronchial aspiration, which is in the adult population mostly secondary to an underlying disorder. In impaired adults with missing dental prostheses there should be extra awareness for this problem. This case report illustrates the importance of a detailed history in case of tracheobronchial aspiration and shows the limitations in the diagnostic usefulness of bedside chest radiography.

Foreign Body Stocked between Vocal Cords

Foreign body (FB) aspiration is a rare event in adults and can mimic other pathologies such as refractory asthma. Most of the objects can be removed using a bronchoscope. Herein, we present a unique case of aspiration of a FB stocked between vocal cords for one week and the anesthetic considerations.