Learning Radiology xray montage

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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