SUCCESSFUL REMOVAL OF A DENTAL CROWN WITH CRYOTHERAPY AND RIGID BRONCHOSCOPY

Abstract

SESSION TITLE: Tuesday Fellows Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM INTRODUCTION: Aspiration of foreign bodies occurs most frequently in extremes of age, and these bodies are commonly lodged in the segment of the right middle lobe.1 Foreign body aspiration in adults is associated with such risk factors as alcoholism, drug abuse, mental retardation, and neuromuscular conditions. The most common foreign bodies aspirated are food and broken fragments of teeth.1,2 Foreign body aspiration can cause such complications as atelectasis, obstructive pneumonitis, bronchial stenosis, and endobronchial actinomycosis.3 CASE PRESENTATION: Our patient is a 47yo M with a known history of epilepsy who presented after his primary care physician found a foreign body on chest x-ray (CXR). One year prior to presentation he had a seizure and a dental crown was dislodged from his front tooth. He immediately experienced wheezing, and minor shortness of breath, but this resolved within days. Nine months later he began to have chest pain, worse in the mornings and with inspiration, moderate in severity, and associated with cough and fever. He was treated with multiple rounds of antibiotics as an outpatient for presumed bronchitis. CXR revealed what was believed to be his crown and a right upper lobe post-obstructive pneumonia. He underwent flexible bronchoscopy, which noted complete occlusion of the entrance of the right upper lobe with granulation tissue surrounding the crown. In order to facilitate the removal of the foreign body, rigid bronchoscopy was used. Forceps failed to grasp the crown, and it was successfully removed with the cryoprobe. During the retrieval the crown was dislodged and moved to the right lower lobe where it was finally removed from the patient. He was noted to have purulent drainage coming from the right upper lobe after removal of the foreign body. He did present to the emergency room three days later for pneumonia and acute hypoxemic respiratory failure. CXR noted diffuse interstitial infiltration and he was admitted for treatment. DISCUSSION: Cryoadhesion has been an effective means of removing foreign bodies, and this modality has been successful with various objects. The cryoprobe has been shown to be most useful with objects that have a high water content given to its ability to obtain sub-zero temperatures in a matter of seconds. CONCLUSIONS: Rigid bronchoscopy has benefit over flexible for centrally located foreign bodies, large amount of granulation tissue, or objects that require manipulation. Complications from rigid bronchoscopy include pneumothorax, bleeding, and hypoxia. Patient selection and the skill level of the operator are crucial in preventing adverse outcomes.2 Reference #1: Oke V., Vadde R., Munigikar P., et al. Use of flexible bronchoscopy in an adult for removal of an aspirated foreign body at a community hospital. Journal of Community Hospital Internal Medicine Perspectives. 2015;5(5):28589. Reference #2: Baharloo F, Veyckemans F, Francis C, Biettlot MP, Rodenstein DO. Tracheobronchial foreign bodies: Presentation and management in children and adults. Chest. 1999;115:1357–62. Reference #3: Folch E, Mehta AC. Foreign body aspiration and flexible bronchoscopy. In: Flexible Bronchoscopy. 3rd edition: Wang KP, , Mehta AC, Turner JF. Chichester, Wiley-Blackwell. 2012, pp 238–49. DISCLOSURES: No relevant relationships by Benjamin Batson, source=Web Response No relevant relationships by Ximena Solis, source=Web Response No relevant relationships by Andres Yepes, source=Web Response