Author(s)
Terence Imbery MD
Joshua Romero MD
Robert Kellman MD
Affiliation(s)
SUNY Upstate Medical University
Abstract:
Educational Objective: At the conclusion of this presentation, the participants should be able to 1) highlight the importance of careful history when evaluating patients with mental handicap for stridor; 2) discuss the challenges associated with laryngoscopy in this setting; and 3) discuss safety implications of non-fixed dentures. Objectives: 1) Highlight the importance of careful history when evaluating patients with mental handicap for stridor; 2) discuss the challenges associated with laryngoscopy in this setting; and 3) discuss safety implications of non-fixed dentures. Study Design: Case report and literature review. Methods: We report a case of a 52 year old male with a history of traumatic brain injury and seizure disorder who presented with breakthrough seizures. He was unable to communicate or cooperate with exam. He was admitted to the neurology service and was noted to have drooling and inspiratory stridor. This initially prompted a speech therapy swallow evaluation, who recommended ENT consultation. Plain film imaging was obtained and unremarkable. Flexible laryngoscopy was performed but inconclusive given patient s poor compliance with exam. Interview of his family revealed that his lower partial denture was missing. Results: The patient was taken to the operating room for direct laryngoscopy and bronchoscopy. GlideScope examination was very helpful in visualizing the upper airway prior to performing instrumentation. This revealed the lower partial denture lodged at the level of the glottis. It was safely removed with cup forceps and a Dedo laryngoscope. Post-removal rigid bronchoscopy was unremarkable. He had immediate relief of his stridor and the remainder of his hospitalization was unremarkable. Conclusions: Dentures can be potentially dangerous airway foreign bodies and are potential hazards in adults with compromised mental status. We would encourage consideration of fixed dentures in these patients to prevent catastrophic consequences.