Original Research
Pharmacist Management of Adult Asthma at an Indian Health Service Facility
A pharmacist-managed adult asthma clinic improved asthma outcomes, patient satisfaction, cost burden, and readmission rates at the Shiprock, New...
It has been recommended to use a gauze throat screen and rubber dam and to avoid a supine position during a procedure, among other techniques, to minimize risk of ingestion or aspiration.2 Imaging studies should be used for further evaluation of the patient; however, some instruments, such as dental pieces and impression material, may not be identified by plain films. In those cases, further evaluation with more sophisticated imaging techniques, such as computed tomography (CT), should be considered.1-10
In a previous case report of a patient who aspirated a third molar during a dental procedure, a chest film failed to identify it. A chest CT was performed, and the object showed in the right main stem bronchus. In another instance, aspiration of impression material in a 45-year-old man was not observed by chest radiography. In this case, the history of coughing and respiratory symptoms days after the procedure pointed toward aspiration of an object as the culprit, with subsequent identification and removal by flexible fiberoptic bronchoscopy.1-11
Bronchoscopy is the treatment of choice for extraction of aspirated foreign bodies; however, there is still a debate about whether to use flexible or rigid bronchoscopy. The decision is usually made based on the object size, localization, medical facility, and personnel expertise. The rigid bronchoscope has the advantages of offering better control and visualization of the airway and easier use of removal instruments. Its primary disadvantage is that the procedure needs to be done in the operating room under general anesthesia. Flexible fiberoptic bronchoscopy done under conscious sedation and topical anesthesia may be as effective as rigid bronchoscopy and even superior in the case of smaller and more distal impacted objects.10-14
In this case, flexible fiberoptic bronchoscopy was used successfully for the removal of the foreign object. Biopsy forceps were used to grasp the object and retrieve it from the airway without complication.
Conclusion
Aspiration of foreign objects during a dental procedure is a potential life-threatening complication. A high-level of suspicion is needed for early diagnosis and referral of the patient for extraction of the object and further avoidance of complications. Flexible fiberoptic bronchoscopy is a feasible procedure for removal of objects within the airway.
Author disclosures
The authors report no actual or potential conflicts of interest with regard to this article.
Disclaimer
The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc. , the U.S. Government, or any of its agencies. This article may discuss unlabeled or investigational use of certain drugs. Please review complete prescribing information for specific drugs or drug combinations—including indications, contraindications, warnings, and adverse effects—before administering pharmacologic therapy to patients.