Br.J. Anaesth. (1976), 48, 371
A FOREIGN BODY IN THE LARYNX A Case Report P. J. NASH SUMMARY
A young patient with a head injury inhaled a dental plate 60 hr after injury.
CASE REPORT
A 19-year-old Army private was admitted to hospital having been struck by a lorry whilst attempting to hitch-hike along a motorway. He was unconscious but responsive to painful stimuli and had facial lacerations, a fractured nose and a compound fracture of his left tibia. He was noted to be bleeding from the left ear, to have blood and probably cerebrospinal fluid in his pharynx, and his three front upper teeth were missing. The pupils were equal and reacting to light. The pharynx and mouth were sucked clear in the casualty department and his trachea was intubated immediately. The facial lacerations were sutured, the fractured tibia was reduced and a full-leg plaster of Paris was applied. During the next 6 h, ventilation appeared to be satisfactory and the endotracheal tube was removed. The patient remained unconscious during the next 48 h, although ventilation was satisfactory, and he developed oliguria with an increase in the blood urea and serum potassium concentrations. He was transferred to the renal unit of this hospital. On arrival, he was found to be unconscious and cyanosed with an obstructive pattern of ventilation, thought to be a result of both the head injury and an accumulation of blood and mucus in the pharynx. It was decided to reintubate the trachea and to ventilate the lungs mechanically. At this time Pa,^ was 49 mm Hg. The mouth and pharynx were sucked dear and, to facilitate endotracheal intubation, the patient was given atropine 0.3 mg followed by suxamethonium 100 mg. Laryngoscopy revealed more blood in the pharynx. P. J. NASH, M.B., CH.B., F.F.A.R.C.S., D.A., Princess Mary's
Royal Air Force Hospital Halton, Aylesbury, Bucks HP22 5PS.
This blood was aspirated, revealing a partial obstruction by an object of flesh-like appearance with a metal spike protruding from it. The spike was grasped with Magill forceps and the object, a dental plate, was removed successfully. Subsequent endotracheal intubation was performed rapidly and easily. The dental plate was incomplete: the teeth had been broken off and were produced later by his companion who had picked them up at the time of the accident. A review of the initial x-rays showed that the dental plate could be detected in situ after the insertion of the original endotracheal tube (fig. 1).
FIG. 1. X-ray taken soon after the initial endotracheal intubation, showing endotracheal tube and oral airway. The wire from the dental plate can be detected in situ in the palate.
Downloaded from http://bja.oxfordjournals.org/ at University of Chicago on July 10, 2015
There are many reports of foreign bodies in the larynx, often with unusual features (Lewis, 1965; Gilbert, 1970; Mehts and Pathak, 1973). This case is reported because of its unexpected presentation.
372
BRITISH JOURNAL OF ANAESTHESIA
Subsequent progress has been slow, but at the time of writing, nearly 4 months after the injury, the patient has made an almost complete recovery. DISCUSSION
ACKNOWLEDGEMENTS
I am indebted to Wing Commander Flynn, M.R.CP., under whose care this patient was admitted, to the Officer Commanding Princess Mary's Royal Air Force Hospital Halton, and to the Director General Medical Services for the Royal Air Force for permission to publish details of this case.
CORPS STRANGER DANS LE LARYNX Rapport sur un cos RESUME
Un jeune patient portant une blessure a la tfite a avale un appareil dentaire 60 heures apres la blessure. FREMDKORPER IM RACHENRAUM Eine FalJbesprechung ZUSAMMENFASSUNG
E8 wird ein Fall eines jungen Patienten mit Kopfverletzungen besprochen, der 60 Stunden nach dem Unfall eine Zahnprothese inhaliert hatte. UN CUERPO EXTRANO EN LA LARINGE Informe de un caso SUMARIO
Un paciente joven con una herida en la cabeza se trag6 una dentadura postiza 60 horas despues de la herida.
Downloaded from http://bja.oxfordjournals.org/ at University of Chicago on July 10, 2015
Foreign bodies, and in particular dental material, often become lodged in the larynx as a result of trauma. Sometimes they are revealed only at the time of endotracheal intubation (Mehts and Pathak, 1973). It is probable that during the transfer from one hospital to the other, the dental plate became dislodged. The plate, which did not have the teeth attached, was similar to that reported by Mehts and Pathak (1973). Dentures of this type are common in young adults, in whom a small number of teeth are missing, and in particular in fit young men involved in contact sports where injury to, and loss of, individual teeth is common. Of course, this age group is frequently involved in accidents of this nature.
REFERENCES
Gilbert, T. J. (1970). An unusual case of inhaled foreign body. Anaesthesia, 25, 391. Lewis, E. B. (1965). Anaesthesia with obstructed airway (removal of an unusual foreign body from the laryngopharynx). Anaesthesia, 20, 196. Mehts, R. M , and Pathak, P. N. (1973). A foreign body in the larynx. Br. J. Anaesth., 45, 755.
A FOREIGN BODY IN THE LARYNX A Case Report P. J. NASH SUMMARY
A young patient with a head injury inhaled a dental plate 60 hr after injury.
CASE REPORT
A 19-year-old Army private was admitted to hospital having been struck by a lorry whilst attempting to hitch-hike along a motorway. He was unconscious but responsive to painful stimuli and had facial lacerations, a fractured nose and a compound fracture of his left tibia. He was noted to be bleeding from the left ear, to have blood and probably cerebrospinal fluid in his pharynx, and his three front upper teeth were missing. The pupils were equal and reacting to light. The pharynx and mouth were sucked clear in the casualty department and his trachea was intubated immediately. The facial lacerations were sutured, the fractured tibia was reduced and a full-leg plaster of Paris was applied. During the next 6 h, ventilation appeared to be satisfactory and the endotracheal tube was removed. The patient remained unconscious during the next 48 h, although ventilation was satisfactory, and he developed oliguria with an increase in the blood urea and serum potassium concentrations. He was transferred to the renal unit of this hospital. On arrival, he was found to be unconscious and cyanosed with an obstructive pattern of ventilation, thought to be a result of both the head injury and an accumulation of blood and mucus in the pharynx. It was decided to reintubate the trachea and to ventilate the lungs mechanically. At this time Pa,^ was 49 mm Hg. The mouth and pharynx were sucked dear and, to facilitate endotracheal intubation, the patient was given atropine 0.3 mg followed by suxamethonium 100 mg. Laryngoscopy revealed more blood in the pharynx. P. J. NASH, M.B., CH.B., F.F.A.R.C.S., D.A., Princess Mary's
Royal Air Force Hospital Halton, Aylesbury, Bucks HP22 5PS.
This blood was aspirated, revealing a partial obstruction by an object of flesh-like appearance with a metal spike protruding from it. The spike was grasped with Magill forceps and the object, a dental plate, was removed successfully. Subsequent endotracheal intubation was performed rapidly and easily. The dental plate was incomplete: the teeth had been broken off and were produced later by his companion who had picked them up at the time of the accident. A review of the initial x-rays showed that the dental plate could be detected in situ after the insertion of the original endotracheal tube (fig. 1).
FIG. 1. X-ray taken soon after the initial endotracheal intubation, showing endotracheal tube and oral airway. The wire from the dental plate can be detected in situ in the palate.
Downloaded from http://bja.oxfordjournals.org/ at University of Chicago on July 10, 2015
There are many reports of foreign bodies in the larynx, often with unusual features (Lewis, 1965; Gilbert, 1970; Mehts and Pathak, 1973). This case is reported because of its unexpected presentation.
372
BRITISH JOURNAL OF ANAESTHESIA
Subsequent progress has been slow, but at the time of writing, nearly 4 months after the injury, the patient has made an almost complete recovery. DISCUSSION
ACKNOWLEDGEMENTS
I am indebted to Wing Commander Flynn, M.R.CP., under whose care this patient was admitted, to the Officer Commanding Princess Mary's Royal Air Force Hospital Halton, and to the Director General Medical Services for the Royal Air Force for permission to publish details of this case.
CORPS STRANGER DANS LE LARYNX Rapport sur un cos RESUME
Un jeune patient portant une blessure a la tfite a avale un appareil dentaire 60 heures apres la blessure. FREMDKORPER IM RACHENRAUM Eine FalJbesprechung ZUSAMMENFASSUNG
E8 wird ein Fall eines jungen Patienten mit Kopfverletzungen besprochen, der 60 Stunden nach dem Unfall eine Zahnprothese inhaliert hatte. UN CUERPO EXTRANO EN LA LARINGE Informe de un caso SUMARIO
Un paciente joven con una herida en la cabeza se trag6 una dentadura postiza 60 horas despues de la herida.
Downloaded from http://bja.oxfordjournals.org/ at University of Chicago on July 10, 2015
Foreign bodies, and in particular dental material, often become lodged in the larynx as a result of trauma. Sometimes they are revealed only at the time of endotracheal intubation (Mehts and Pathak, 1973). It is probable that during the transfer from one hospital to the other, the dental plate became dislodged. The plate, which did not have the teeth attached, was similar to that reported by Mehts and Pathak (1973). Dentures of this type are common in young adults, in whom a small number of teeth are missing, and in particular in fit young men involved in contact sports where injury to, and loss of, individual teeth is common. Of course, this age group is frequently involved in accidents of this nature.
REFERENCES
Gilbert, T. J. (1970). An unusual case of inhaled foreign body. Anaesthesia, 25, 391. Lewis, E. B. (1965). Anaesthesia with obstructed airway (removal of an unusual foreign body from the laryngopharynx). Anaesthesia, 20, 196. Mehts, R. M , and Pathak, P. N. (1973). A foreign body in the larynx. Br. J. Anaesth., 45, 755.
