Abstract Foreign body aspiration (FBA) among adults remains an infrequent and often under-recognized clinical event. While tooth aspiration constitutes the most identified object, simultaneous aspiration of two teeth is exceedingly unusual in patients exhibiting post-oncologic modifications of the airway. This report presents a complex case involving dual tooth aspiration in a patient with significant trismus following oral cancer therapy, offering insight into both diagnostic and airway management challenges. A 65-year-old female with a history of squamous cell carcinoma of the oral cavity had previously undergone extended glossectomy, modified neck dissection, free flap reconstruction, and adjuvant radiotherapy. She presented with a 15-day history of fever, cough, and progressing dyspnea. Severe trismus resulting from prior radiation therapy. She presented with respiratory distress with oxygen saturation at 85% on room air and Type I respiratory failure on arterial blood analysis. Chest radiography demonstrated an opacity of the left main bronchus with left lower lobe consolidation. Computed tomography (CT) scans revealed left lower lob consolidation, mild pleural effusion, and hyperdense areas within the oropharynx and left bronchus, suggestive of foreign bodies. The patient was stabilized with high-flow oxygen therapy and broad-spectrum antibiotics prior to transfer for urgent removal of the foreign objects. Nasal fibreoptic bronchoscopy detected a tooth situated in the oropharynx, which was carefully maneuvered above the vocal cords and extracted. Restricted mouth opening necessitated nasal intubation employment for airway access. A second tooth, found impacted in the left main bronchus, required a tracheostomy for retrieval. Utilizing a Fogarty balloon and snare, the tooth was dislodged and removed via the tracheostomy site. Subsequent bronchoscopy confirmed complete airway clearance. The patient’s respiratory status improved markedly, permitting discharge for follow-up. In patients who have undergone radiotherapy, trismus introduces challenges in gaining airway access, performing intubation, and navigating bronchoscopic instruments. Clinical vigilance must be maintained given that teeth may not always be visible on imaging, despite being radiopaque. The management of this patient required a multifaceted approach of combining nasal bronchoscopy-guided intubation and tracheostomy emphasizing adaptable airway management in preventing serious complications, such as persistent pneumonia, airway granulation tissue formation, and respiratory failure. Furthermore, radiation-induced trismus and dental damage considerably elevate the risk of loose teeth and subsequent aspiration in individuals with head and neck cancer. Early dental evaluation is an essential strategy to avert life-threatening events. When loose teeth are detected in such patients, immediate removal by a dental professional is strongly advocated to prevent aspiration. This abstract is funded by: None
Nandi et al. (Fri,) studied this question.