An aspirated partial denture as a complication in status epilepticus

Excerpt

A 78-year-old male was transferred to the emergency department with loss of consciousness and tonic-clonic seizures. The patient’s history included post-stroke epilepsy, dementia and chronic psychosis under medical treatment. Initial treatment with lorazepam followed by phenytoin proved ineffective. Refractory status epilepticus was clinically diagnosed, and the patient was admitted to the ICU for further treatment and follow-up. After remission of the seizure, persistence of salivation and dysphagia necessitated examination by flexible endoscopy (Fig. 1a), which revealed a partial denture, aspirated and embedded in the laryngeal entrance, from the supraglottic to the postcricoid space. Due to the foreign body’s position together with serious comorbid conditions, such as coronary artery disease, cardiac insufficiency, a prosthetic metallic cardiac valve and diabetes, general anesthesia via laryngeal intubation was prohibited. A thorough evaluation of the clasp assembly’s arm orientation, with the help of plain films (Fig. 1b, c) and the consultation of an experienced dental surgeon was performed.

The foreign body was removed without sedation, with a fiberoptic rhinolaryngoscope using a transorally inserted Fraenkel laryngeal forceps (Fig. 1d, video). Minimal patient resistance and disturbance of the laryngeal epithelium was observed. …