Difficult Endotracheal Intubation - Aspirated Tooth

General Considerations

• With difficult intubation, practitioner tends to increase lifting forces of laryngoscope blade
• May lead to damage of intraoral tissues and osseous structures
• Dental injuries associated with intubation
• Maxillary central incisors are at most risk
• Fifty percent of dental trauma from intubation happens during laryngoscopy itself
• 23% occurs following extubation
• Dental injuries are more common in
• Small children
• Patients with periodontal disease or fixed dental work
• Patients in whom intubation is difficult
• If an entire tooth is avulsed, it can be retrieved and saved in moist gauze or  normal saline
• With a rapid response from an oral surgeon or dentist, an intact tooth can be re-implanted and saved, usually when performed within 1 hour
• Aspiration is more likely to occur into the right lower lobe
• Because of straighter path and wider bore of right main bronchus
• Aspiration of the tooth may induce serious complications requiring bronchoscopy for removal
• Obstructive pneumonia
• Atelectasis
  

Other injuries

• Lip injuries
• Lacerations
• Hematomas
• Edema
• Teeth abrasions
• Usually secondary to inattentive laryngoscopy performed by inexperienced practitioners
• Massive tongue swelling (macroglossia) has been reported
• Damage to the uvula (edema and necrosis) usually associated with an endotracheal tube
• Sore throat, odynophagia, painful swallowing have been reported
• Incidence of sore throat after intubation is approximately 40%
• >65% when blood is found on airway instruments
• Trauma to larynx and vocal cords is not uncommon following endotracheal intubation
• In one large study, 6.2% of patients sustained severe lesions to larynx
• Recovery is generally prompt with conservative therapy
• Hoarseness may be present even after a 2-week interval
• Arytenoid dislocation and subluxation have been reported as rare complications

Tooth in Right Lower Lobe Bronchus. Close-up of the right lower lobe on a frontal view of the chest (left) demonstrates a calcified density overlying the right lower lobe (black circle). The patient has pulmonary contusions as a background. An image from an axial CT scan of the chest (right) using "bone "windows clearly shows a tooth in the right lower lobe bronchus (white circle). There is a pulmonary contusion surrounding the tooth. The patient expired from massive head injuries before the tooth could be removed.
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