Retrieval of aspirated dental equipment from a lung

Excerpt

During dental treatment, an air-water syringe tip (Quick-Disconnect Syringe; A-dec, Newberg, OR, USA) was propelled into the trachea of a 68-yr-old man with a history of severe chronic obstructive pulmonary disease (COPD) and significant cigarette use. Normally, the syringe tip is secured to its handle by pushing it firmly past an O-ring connector. In this case, it is believed the tip was not securely fastened and thus became dislodged during use. Because the patient denied any symptoms of choking, coughing, or gagging, there was disbelief that he had aspirated the irrigating instrument. Nonetheless, he was sent to hospital, where a chest radiograph revealed an 8-cm long foreign body (FB) in the distal left mainstem bronchus (panel A). General anesthesia with endotracheal intubation and positive-pressure ventilation was utilized for its successful retrieval via bronchoscopy (panel B). Although maintenance of spontaneous ventilation is frequently employed during FB removal to avoid dislodgement, complete obstruction, or creation of a ball-valve effect,1,2 it was thought unnecessary in this case given the narrow shape, inflexible material, and distal location of the FB. Dental procedures are a known risk factor for adult FB aspiration.1 We believe the patient’s heavy cigarette use and COPD may have contributed to blunting his airway reflexes and his lack of symptoms.

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