Dr. Mumin Hakim (PGY2), Dr. Stephanie Serrato (PGY4)
68-year-old male with a past medical history of seizures (adherent with Vimpat 50mg thrice daily) presents to the ED with complaints of sore throat s/p GTC seizure. Per patient’s ex-wife at bedside, he had a seizure the day prior lasting for 30 mins at 3AM. At this time, there was concern wherein he possibly swallowed his partial denture.
On initial exam, patient had a husky voice, no added breath sounds. It was determined that the patient should be taken for a stat neck and chest X-Ray. X-Ray was notable for a radiopaque object within the hypopharynx that corresponds with given clinical history of swallowed partial dentures.
On identification, patient was taken to the trauma bay and ENT was stat paged. Ambuscope procedure was performed by ENT resident, confirming the partial denture present in supraglottic airway. ENT tried using tonsil forceps to remove denture while visualizing the denture via ambuscope. Ambuscope images obtained, although not ideal due to obscuration of the ambuscope screen, and added below.
Ambuscope-led extraction failed twice with ENT resident. ER resident offered to try using Glidescope for visualisation and tonsil forceps for removal. ENT attempted a third ambuscope-led extraction with no success. At this point, the patient’s airway had some blood and mucous secretions and, at this point, the ED resident took over and used tonsil forceps and Glidescope for visualisation.
Using the tonsil forceps, the ER resident was able to visualize and grasp the denture. It was determined that, due to 2 hooks in the partial denture, the denture was caught on the posterior tonsillar pillar/uvula and may have also been affixed to the supraglottis. Once this was understood, the denture was twisted to let loose the two ends and was ultimately removed.
Continuing Management:
CTH/neck soft tissue showed no acute findings
Tdap was given, Dexamethasone administered for edema, Augmentin 10 day course
The patient was observed in the ED for 4 hours and discharged in a stable condition with ENT follow up
Mumin’s Takeaways:
When pulling out a foreign body, the anatomy of the foreign body and location can be used to manoeuvre the foreign body out.
Always remember our elderly patients may have dentures.
When conducting any ambuscope-led procedure, have all back ups ready (DL/VL/bougie/cric).
Glycopyrrolate could be used for secretions.
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