The Hidden Dangers of Dental Trauma: A Case of Foreign Body Aspiration in Complex Airway Management

Introduction: Acute respiratory failure (ARF) presents significant challenges, especially when complicated by unknown etiologies and airway obstructions. We present a case of a 55-year-old male who developed ARF after using a peroxide gargle, leading to acute airway obstruction and necessitating emergency intervention.


Description: A 55-year-old male with an unknown medical history presented to the emergency department in acute respiratory distress after using a peroxide gargle for a sore throat. In the ED, he exhibited angioedema and signs of acute epiglottitis. Initial treatment was with IV Diphenhydramine and Epinephrine. Due to concern for airway obstruction, it was decided to intubate the trachea.

After multiple failed attempts to intubate, an emergency cricothyroidotomy was performed. Once the airway was secured and the patient stabilized, he underwent further tests. Chest X-rays showed 2 teeth in the carina and bronchus, Chest CT showed lower lobe consolidations, pulmonary edema and the aspirated teeth. A CT and MRI of the neck showed extensive edema, interstitial air in the pharynx, larynx occlusion, and 2 tonsillar and retropharyngeal abscesses.

The patient's cricothyroidotomy was converted to a tracheostomy and he underwent bronchoscopic removal of the foreign bodies. Laryngoscopy revealed additional wooden and plastic objects. The patient later disclosed a history of trauma. He was struck in the face a few years ago causing loose teeth and resorted to self-made dental retainers. The patient was eventually weaned from the mechanical ventilator, transitioned to a tracheostomy collar and was discharged home with appropriate follow up care.


Discussion: This case illustrates the need for rapid assessment and intervention in acute airway obstruction of unknown etiology, emphasizing a broad differential diagnosis. It highlights the complexities of managing ARF due to allergic reactions, foreign body aspiration, and potential complications of emergency intubation. Previous studies on the use of dental devices during endotracheal intubation are limited. Future research should focus on larger cohort studies to evaluate the safety and efficacy of protective devices during difficult airway management to improve patient outcomes especially in the setting of poor oral hygiene or prior trauma.