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• W2894853242 abstract "SESSION TITLE: Procedures SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Tooth aspiration is a rare complication of endotracheal intubation with an estimated incidence of 1% (some studies report as high as 12%).(1) Although rigid bronchoscopy has traditionally been used for foreign body extraction, flexible bronchoscopy has been successful in numerous case series.(2,3) The superior safety profile of flexible bronchoscopy as well as advancements in endoscopic tools have made this the modality of choice for attempting removal of foreign bodies from the airways.(3) Here, we present a challenging case of an aspirated tooth in an intubated patient. CASE PRESENTATION: A 64-year-old man with cardiovascular disease and recent cerebral vascular accident was admitted to the medical intensive care unit after emergent intubation for acute respiratory failure. A post-intubation chest radiograph revealed a new right upper lobe opacity and an appropriately placed endotracheal tube (ETT). As the cause of cardiopulmonary arrest was unclear, a computed tomography angiogram of the pulmonary arteries was performed; there was no pulmonary embolism, but in the right main bronchus there was a large, oblong, calcified foreign body suspicious for a tooth. Although likely traumatically displaced during intubation, an aspirated tooth could also cause hypoxia and cardiac arrest requiring cardiopulmonary resuscitation. Rat-tooth forceps and a retrieval net were used via flexible bronchoscope to attempt removal of the tooth; other tools were not immediately available (such as a wire grasping basket, which has more commonly been used to remove smooth inorganic foreign bodies from the airways). The rat-tooth forceps were unable to grasp the smooth surface of the tooth. Multiple attempts were made with the retrieval net before the tooth was secured as the ventilator positive pressure and the sheath frequently pushed the tooth into the more distal airways. Ultimately, trendelenburg positioning and suction were used to bring the tooth to the larger airways where it was captured by the retrieval net. Due to the large size of the tooth, the net, bronchoscope, and ETT were removed en bloc and the patient was reintubated uneventfully. DISCUSSION: This case demonstrates the use of a retrieval net, a tool actually developed for gastrointestinal endoscopic procedures, in the removal of an aspirated foreign body via flexible bronchoscopy. Retrieval nets are particularly useful for small round objects (such as button batteries or teeth) and soft materials that may fragment. Multiple tools exist for extracting aspirated foreign bodies including biopsy forceps & grasping forceps, wire baskets, prong snares, and cryoprobes, but these devices may not be available in centers lacking Interventional Pulmonology.(3) CONCLUSIONS: The flexible bronchoscope is an excellent option for removal of foreign bodies from the airways, provided the appropriate tools are available. Reference #1: Vogel J, Stübinger S, Kaufmann M, Krastl G, Filippi A. Dental injuries resulting from tracheal intubation--a retrospective study. Dent Traumatol. 2009;25(1):73-7. Reference #2: Blanco Ramos M, Botana-Rial M, García-Fontán E, Fernández-Villar A, Gallas Torreira M. Update in the extraction of airway foreign bodies in adults. J Thorac Dis. 2016;8(11):3452-3456. Reference #3: Sehgal IS, Dhooria S, Ram B, Singh N, Aggarwal AN, Gupta D, Behera D, Agarwal R. Foreign Body Inhalation in the Adult Population: Experience of 25,998 Bronchoscopies and Systematic Review of the Literature. Respir Care. 2015;60(10):1438-48. DISCLOSURES: No relevant relationships by Marcos Restrepo, source=Web Response No relevant relationships by Robert Winsett, source=Web Response" @default.
• W2894853242 created "2018-10-12" @default.
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• W2894853242 date "2018-10-01" @default.
• W2894853242 modified "2023-10-16" @default.
• W2894853242 title "NOTHING BUT NET: SUCCESSFUL TOOTH RETRIEVAL VIA FLEXIBLE BRONCHOSCOPY" @default.
• W2894853242 doi "https://doi.org/10.1016/j.chest.2018.08.766" @default.
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