Video: 2010 ABEA Presidential Citation for Foreign Body Management

A Challenging Case: Intubation through a Foreign Body and Foreign Body Removal from the Larynx

Vartan A. Mardirossian, MD
Boston, MA

Timothy Anderson, MD* 
Burlington, MA 

Joyce Colton-House, MD* 
Boston, MA

The patient was a 70-year old man with chronic dysphagia and altered mental status after fall who was seen in a tertiary care center clinic for sudden significant worsening of the dysphagia, dysphonia and drooling over the past several hours. The fiberoptic exam of the larynx showed that a complete superior denture was lodged around the epiglottis with the teeth in the valleculae and the metallic frame and hooks against the posterior wall of the hypopharynx. A single attempt was made to remove it in clinic but this was unsuccessful. During the visit and in the hour to follow the patient developed signs of mild-moderate airway obstruction but maintained good oxygenation. He was brought urgently to the OR where he was fiberoptically intubated. 

Given the particular position and the conformation of the foreign body the intubation was performed through it. Subsequently, with the help of endoscopic forceps the denture was slid upwards and out along the endotracheal tube; once the denture was out of the patient's mouth, the anesthesia circuit had to be interrupted in order to complete its removal from the end of the endotracheal tube.

Despite some mild edema of the epiglottis and the aryepiglottic folds caused by the prolonged presence of the foreign body in the upper airway, the patient was successfully extubated, and then transferred to the postoperative care unit and then to the floor in stable conditions.