Dentures discovered in larynx 8 days after general anaesthetic

Abstract

An active 72-year-old man presented to the accident and emergency department (A&E) with odynophagia, dysphagia and haemoptysis 6 days after a minor operation and was discharged after treatment for an aspiration pneumonia. He presented to A&E 2 days later with worsening symptoms and was found to have dentures lodged in his larynx which were then removed in theatre. For 6 weeks after removal, he had periodic episodes of frank haemoptysis requiring multiple blood transfusions and, after extensive investigation, was found to have an erosion into an arterial vessel on his right parapharyngeal wall, just posterior to the glossopharyngeal sulcus. This case raises questions about perioperative care in patients with dentures, diagnostic decision-making in the emergency care setting and postoperative care after delayed removal of foreign bodies from the upper aerodigestive tract.

Ill Effects and Complications Associated to Removable Dentures With Improper Use and Poor Oral Hygiene: A Systematic Review

“…After discovering and removing the dentures, he developed aspiration pneumonia and hemoptysis due to granulation tissue formation. This study concluded that any dental prosthesis should be documented before and after any procedure, and the perioperative strategy should be communicated to all members of the operating room [ 6 ].…”

“…Aspiration pneumonia, halitosis, infective endocarditis, septic meningitis, and other complications can result from biofilm formation. In addition, accidental aspiration and ingestion of dentures are also more common in the elderly; potential risk factors include alcoholic intoxication, advancing dementia, stroke, and epilepsy [ 6 ]. Necrosis, perforation, ulceration, fistula formation, penetration of neighboring organs, bleeding, and obstruction are risks associated with ingesting dentures [ 6 - 7 ].…”

Swallowed Dentures: An Analysis of Denture Impaction Events in Pennsylvania

“…Patient gender was specified in all but one case report and in all case series, and about 8 out of every 10 patients were male. [3][4][5][6][7][8][9][10][11] Patient gender was specified for patients in all but one of the retrospective reviews that were analyzed; nearly 7 out of 10 patients in these reviews were male. 41-45 While it seems clear that men are more likely to experience a denture impaction event, the reason for this is unclear.…”

“…Several patients were unaware that they had swallowed a denture, so the healthcare provider lacked that information when attempting to identify the etiology of the patient's symptoms. 3,9,29,33,36 Notably, the patient's symptoms in two cases were initially attributed to a suspected malignancy in the sigmoid colon, but surgical resection led to the identification of an impacted partial plate in both cases. 9,16…”

“…After reading about a denture impaction event involving a man in England who swallowed his dentures while under anesthesia for a surgical procedure, we queried the Pennsylvania Patient Safety Reporting System (PA-PSRS) to identify and analyze denture impaction events that have occurred in Pennsylvania. 3 Although the patient safety event reports reviewed are only from acute care facilities, we believe the insights from our analysis will be universally beneficial to healthcare providers in all practice settings-including primary care providers and dentists-as well as to patients who wear dentures or their caretakers.…”