Thoracoscopic removal of dental prosthesis impacted in the upper thoracic esophagus

Luigi Bonavina,Stefano Siboni,Alberto Aiolfi,Emanuele Rausa

doi:10.1186/1749-7922-9-5

Abstract

Dental appliances are the most common cause of accidental foreign body esophageal impaction, especially in the elderly population with decreased oral sensory perception. A 47-year-old man with history of oligophrenia and recurrent epileptic seizures was referred to our hospital following dislocation and ingestion of his upper dental prosthesis. Endoscopic removal and clipping of an esophageal tear had been unsuccessfully attempted. A chest CT scan confirmed entrapment of the dental prosthesis in the upper thoracic esophagus, the presence of pneumomediastinum, and the close proximity of one of the metal clasps of the prosthesis to the left subclavian artery. A video-assisted right thoracoscopy in the left lateral decubitus position was performed and the foreign body was successfully removed. The patient was then allowed to wear the retrieved prosthesis after dentistry consultation and repair of the wire clasps by a dental technician. At the 6-month follow-up visit the patient was doing very well without any trouble in swallowing.

Highlights

Accidental ingestion of foreign bodies is frequent in adult individuals with mental retardation or psychiatric disorders
We present a case of successful thoracoscopic removal of dental prosthesis impacted in the upper thoracic esophagus
It is reasonable to estimate that, with the growth of the denture-wearing population, the incidence of impacted dentures in the esophagus may increase in the future

Summary

Introduction

Accidental ingestion of foreign bodies is frequent in adult individuals with mental retardation or psychiatric disorders. 10-20% of the patients may require endoscopic removal, and 1% or less may require surgery due to entrapment of the foreign body in the cervical (57%), thoracic (26%), or distal (17%) esophagus [1]. The esophagus was opened longitudinally for approximately 4 cm and the prosthesis (five dental elements with three metal clasps) was removed under direct endoscopic and thoracoscopic view using an endograsper (Figure 2A-B), and enveloped in a plastic bag. The patient was allowed to wear the retrieved prosthesis after repair of the wire clasps by a dental technician and dentistry consultation. He was discharged well from the hospital on postoperative day 8 on a free diet. At the 6-month follow-up visit the patient was doing very well without any complaint in swallowing

Discussion

Findings

Foreign body removal Good