A Crumpet, a Canine and a Cryoprobe: A Case of Tooth Aspiration

TL;DR

A 66-year-old man aspirated a canine tooth, causing pneumonia and sepsis, which was successfully treated by removing the tooth with a cryoprobe.

Contribution

Demonstrates the successful use of a cryoprobe for retrieving an aspirated tooth in a clinical case.

Findings

Tooth aspiration can lead to post-obstructive pneumonia and sepsis.

A cryoprobe was effective in removing the aspirated canine tooth.

Timely intervention is crucial for source control in such cases.

Abstract

Foreign body inhalation can lead to post‐obstructive pneumonia and sepsis, requiring timely removal to achieve source control. We report a case of tooth aspiration successfully retrieved with a cryoprobe.

A 66‐year‐old man presented with sepsis secondary to post‐obstructive pneumonia following aspiration of a canine tooth. The tooth was successfully removed with a cryoprobe.

Figures

Full text

A 66‐year‐old man presented to hospital with a 1‐week history of a productive cough following inadvertent aspiration of a canine tooth while eating a crumpet. On examination, he was febrile (38.2°C), tachycardic (heart rate 125 beats per minute), hypotensive (systolic blood pressure 90 mmHg), with coarse crepitations audible at the right lung base. His white cell count was 10.6 × 10^9^/L and his CRP was 308 mg/L. Chest x‐ray (Figure 1) and subsequent computed tomography (Figure 2) demonstrated a lucency at the orifice of the right lower lobe bronchus, with post‐obstructive consolidation and collapse. He was treated with intravenous antibiotics and underwent a flexible bronchoscopy which demonstrated a tooth lodged within the right lower lobe bronchus resulting in distal obstruction. A 1.1 mm cryoprobe was used to remove the tooth, and extensive mucopurulent secretions were suctioned (Figure 3).

Foreign body aspiration is relatively uncommon in adults. Removal of the aspirated material is essential to prevent complications including airway mucosal ulceration and post‐obstructive pneumonia. While at times either rigid bronchoscopy or traditional grasping devices (forceps, basket) may be suitable to remove aspirated teeth, a cryoprobe can be an effective alternative if the tooth pulp is exposed or there is mucus adherent to it [1, 2].

Author Contributions

Matthew Donnan, Melanie Wong and Elina Chi: conceptualisation, draft writing, review, editing. Dominic Keating: supervision, writing – review and editing.

Consent

The authors declare that written informed consent was obtained for the publication of this manuscript and accompanying images using the consent form provided by the Journal.

Conflicts of Interest

The authors declare no conflicts of interest.