Accidental aspiration of dental foreign body

A 65-year-old non-smoker patient came to the Emergency Department referring to a dental procedure 5 days earlier, with an accidental fall of a metal piece in the oral cavity, initially considered probable ingestion due to the absence of immediate respiratory symptoms.

A chest X-ray was taken showing a metallic foreign body (FB) ([Abb. 1]). A chest CT scan was then performed ([Abb. 2] [3]) showing metallic FB located in the lumen of the posterior bronchus (B10) of the right lower lobar bronchus.

Abb. 1

Abb. 2

Abb. 3

An urgent bronchoscopy was performed and an elongated metallic object ([Abb. 4]) was located in the right basal pyramid. Initially an attempt was made to extract it with biopsy forceps, but it slipped (problems with the traction force). We then tried to extract it with a basket, but succeeded after several attempts. Subsequently we found that the object was a metal piece used for dental implants (angled multi-unit abutment) 34 millimetres long ([Abb. 5]).

Abb. 4

Abb. 5

We confirmed with X-ray that there were no complications ([Abb. 6]). The patient was discharged completely asymptomatic.

Abb. 6

Discussion In most cases FB is located in the right bronchial tree, due to the greater verticality of the right main bronchus and its larger diameter.

Chest radiography is pathological in 70-90% of patients. Metallic solid bodies are easily identified in their anatomical tracheobronchial location. When not detected on X-ray, atelectasis, pneumonitis, air trapping or mediastinal displacement may be suspected.

Flexible bronchoscopy is effective in 90% of cases and is the treatment of choice. Various devices for FB removal are described in the literature, such as conventional biopsy forceps, special foreign body forceps (alligator type), some magnetic probes, metal hooks, baskets (metal or synthetic), inflatable balloon catheters or even cryoprobes.

Rigid bronchoscopy is required in 8% of patients and allows better control of the airway as well as management of complications. Surgical treatment is reserved for the remaining 2% of patients.

In conclusion, our case demonstrates the importance of always trying to remove the FB with flexible bronchoscopy, avoiding more invasive techniques. We have not found any other case of aspiration with this particular type of material (angled multi-unit abutment) in the literature.

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Artikel online veröffentlicht:
01. März 2024