Abstract Introduction Tooth aspiration is a rare but recognized complication of endotracheal intubation. Bronchoscopy is a commonly used modality for retrieval of aspirated foreign bodies. However, the removal of an aspirated tooth presents a unique challenge due to its round shape, smooth surface, potential mobility within the airway, and lack of innate soluble content. Prior literature discusses the use of forceps or baskets to remove an aspirated tooth. In this case, we discuss the successful use of cryotherapy as an alternative technique for retrieval of the crown of a tooth from the airway. Case A 60-year-old man with complex cardiac history and recent cardiogenic shock due to STEMI requiring intubation and extracorporeal membrane oxygenation (ECMO) was transferred to our facility for evaluation and intervention of foreign body in the lung. CT imaging showed atelectasis at the lung bases and a 2 x 1 cm metallic foreign body in the right lower lobe hilar region. This was presumed to be a tooth from recent traumatic intubation. The patient was minimally symptomatic. Bronchoscopy was performed showing mucus plugging of the posterior basal segment of the right lower lobe which was suctioned. A foreign object was identified as the crown of a tooth and successfully removed via multimodal efforts utilizing forceps and cryoprobe. Discussion Trauma to the oral cavity during intubation remains one of the most common risks of endotracheal intubation, and several cases have reported attempts at foreign body removal using bronchoscopy. In one case series, flexible bronchoscopy with a fishnet basket was used to attempt retrieval of aspirated teeth in six critically ill patients with artificial airways. In that study, extraction was successful in four patients. In two of the cases, removal was not possible due to tooth impaction in the distal bronchus. Two additional case reports describe successful removal a dental bridge and a tooth using cryoadhesion. The innate properties of these foreign bodies make removal inherently difficult due to low soluble content. The buildup of mucous on the tooth in this case may have provided sufficient soluble content to successfully remove the aspirated foreign body using multimodal therapies. This abstract is funded by: None
Purzycki et al. (Fri,) studied this question.