Fiberoptic Bronchoscopic Removal of Dental Crown Dropped in Bronchus During Dental Treatment
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2018, Vol 11, Issue 5
Abstract
Background: Aspiration and ingestion of foreign bodies are rare and risky complication during dental procedure. For a metal paradium with a very smooth surface stuck in the lower endobronchus, it was difficult to grasp and remove. Fortunately, we could remove it by a minimally invasive technique by flexible bronchoscopy. Case Report: A 57-year old male diagnosed with schizophrenia had been treated for tooth decay. During covering a dental crown, the palladium was dropped in the oral space. As he had a continuous cough, the dental crown was suspected to be aspirated, thus he was transferred to a hospital. Chest radiography showed an artifact in the left lower lung field, which showed a foreign metal body in the left basal segmental bronchus of B9 of the lung. An endobronchial foreign body was diagnosed, and endoscopic removal was needed as the first step before surgical removal. Under airway anesthesia, a flexible bronchoscopy was guided to the stuck dental crown in the B9 bronchus, which was successfully removed by grasping with alligator forceps. A foreign body in an airway is typically observed in children under 3 years old and in elderly people [1]. For respiratory physicians, they encounter a bronchial foreign body and generally observe the foreign bodies in elderly patients which often include all kinds of foods, dentures and dental crowns [2]. In older patients, the risk is higher due to the reduced gag reflex, and other age-related general diseases such as dementia due to Parkinson’s disease [3]. Once a foreign body is sometimes stuck in the trachea and bronchial space, and if it could not be discharged, it might cause asphyxia and pneumonia, thus an accurate diagnosis and prompt removal should be demanded. In recent years, for almost all cases of airway foreign bodies, the removal was performed by fiberoptic bronchoscopy. Based on the National Survey 2010 by the Japan Society for Respiratory Endoscopy [4], 681 cases of airway foreign body removal were reported and 662 (97%) of which had been performed using a fiberoptic bronchoscopy. As a treatment of the foreign body in the airway, fiberoptic bronchoscopy was the first choice for its removal. However, it sometimes becomes a difficult removal of a very smooth surface of metallic dental prostheses. There are a few reports regarding the effective extraction of dental prostheses from the airway [5-7]. The irregular surface and hard composition of dental prostheses make them very difficult to grasp and extract using normally effective instruments (biopsy forceps, Fogarty balloon catheters, alligator forceps, or wire baskets). Moreover, their sharp edges can facilitate impaction. For these reasons, we report the successful removal of a dental crown using a flexible bronchoscope, which was deeply inserted and nearly totally occluded the left lower peripheral bronchial tree. Case Report A 57-year-old male diagnosed with schizophrenia had been treated for tooth decay. During covering a dental crown, the palladium was dropped in the oral space. He had a continuous cough and was suspected of aspiration of the dental crown thus he was transferred to another hospital. Chest radiography showed a metallic foreign body in the left lower lung field (Figures 1A & 1B) and he visited the emergency department of our hospital. Chest computed-tomography showed an artifact, that is, a foreign metal body in the left basal segmental bronchus of B9 of the lung (Figures 2A-2C). An endobronchial foreign body was diagnosed, and endoscopic removal was scheduled as the first steps before surgical removal. Under airway anesthesia, a flexible bronchoscopy was guided to the stuck dental crown in the B9 endobronchus (Figure 3A), which was grasped (Figure 3B) and successfully removed by alligator forceps. As the dental crown is made of palladium with a smooth surface, and firmly fixed the peripheral bronchus, it should be difficult to remove, however, we could strongly grasp it using alligator forceps for a digestive endoscope.
Authors and Affiliations
Takanori Ayabe, Masaki Tomita, Ryo Maeda, Kunihide Nakamura
Keywords
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- EP ID EP587158
- DOI 10.26717/BJSTR.2018.11.002167
- Views 152
- Downloads 0
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