DENTAL APPOINTMENT TO ICU ADMISSION: BRONCHIAL ASPIRATION OF A DENTAL TOOL DURING CROWN IMPLANTATION

TOPIC: Procedures TYPE: Fellow Case Reports INTRODUCTION: Foreign body aspiration during a dental procedure is rare but deadly complication with an incidence of 0.001 per 100,000 [1]. In fact, 92% foreign bodies entered the gastrointestinal tract, only 8% being aspirated into respiratory tract [2]. A hex screwdriver used in oral surgery to secure crown implantation. We report case accidental bronchial driver discuss risk factors for aspiration, radiographic features diagnosis, and management retrieval. CASE PRESENTATION: 67-year-old male no significant past medical history presents emergency department sent from clinic. The patient was undergoing implantation when procedure, implant accidentally dislodged aspirated. ED, he complained minor cough right-sided pleuritic chest pain. Vital signs physical examination were unremarkable. Chest x-ray showed radiopaque object projecting over right infrahilar region. intubated airway protection, admitted intensive care unit planned emergent bronchoscopy. Flexible fiberoptic bronchoscope performed revealing lodged lower lobe point down (figure 2). retrieved using basket net. During bronchoscopy, anatomical abnormalities identified tracheobronchial tree. subsequently extubated discharged following day. DISCUSSION: Aspiration instruments serious leading compromise, perforation, mediastinitis, death. Risk DFBA include elderly patients, children, those neurocognitive deficits. also manipulation tools procedures. Symptoms cough, dyspnea, lack breath sounds, wheezing All objects lost procedures should be assumed aspirated/ingested even if patients are asymptomatic as delays diagnosis lead greater morbidity. Most detected on radiographs. Bronchus intermedius most common site impaction due larger diameter straighter course. Once confirmed, flexible or rigid bronchoscopy retrieve object. retrieval forceps, nets, snares, cages, Fogarty balloon, magnets. If bronchoscopic removal fails, surgical intervention such lobectomy indicated [3]. CONCLUSIONS: Dental potentially fatal requiring prompt recognition, treatment. Recognition imaging via essential prevent long-term sequelae. REFERENCE #1: Susini G, Pommel L, Camps J. Accidental ingestion root canal other French population. Int Endod 2007 Aug;40(8):585-9 #2: Yadav RK, HK, Chandra A, S, Verma P, Shakya VK. aspiration/ingestion dentistry: clinical legal perspective. Natl J Maxillofac Surg. 2015 Jul-Dec;6(2):144-51. #3: Hou R, Zhou H, Hu K, Ding Y, Yang X, Xu Xue Shan C, Jia Ma Y. Thorough documentation necessary: review analysis 617 cases. Head Face Med. 2016 Jul 22;12(1):23. DISCLOSURES: disclosure file Jagadish Akella; No relevant relationships by Shiva Arjun, source=Web Response Javed Iqbal, Eric Lam, Raghavendra Sanivarapu,