The swallowing of dentures during general anaesthesia is a significant problem for anesthesiologists. It is seen more often in patients with psychiatric disorders, mental retardation, alcoholism, or poor quality dentures. It has become an important issue for anesthesiologists preoperatively due to the increase in the proportion of dentures associated with prolongation of life. In elderly, the use of partial fixed prosthesis increases and the risk of swallowing dentures is increased. In this case report, it was presented that the denture was swallowed spontaneously before intubation while the patient was ventilated preoperatively.
The swallowing of prostheses is an important problem for general surgery, gastroenterology, anesthesiology, psychiatry, neurology, and emergency medicine. In adults, swallowing foreign bodies is seen less frequently. However, it is seen more often in adults with psychiatric disorders, mental retardation, alcoholism, or poor quality dentures [
Most anesthetists work from the mouth. To prevent perioperative dental damage and complications, it is important to determine the dental status of the patient and identify any sensitive teeth or soft tissues and the anesthesia risk factors associated with these in a full preoperative evaluation. Nowadays, many patients have dentures which are more fragile than the natural teeth. The increased use of partially fixed dentures in the elderly increases the possibility of swallowing prostheses. This possibility is often overlooked. If it is not noticed that the patient has partial dentures, there is a possibility that the denture will be pushed into the oesophagus and swallowed during ventilation with positive pressure following preoperative induction. This is a rarely seen complication for anaesthetists.
In this paper, the uncommon case is presented of a patient who swallowed a denture which dislodged as a result of the positive pressure created during preoperative ventilation and in the postoperative period, it spontaneously passed through the intestinal canal without any harm to the patient.
A 50-year-old male presented at the General Surgery Polyclinic due to increased complaints of swelling and intermittent pain in the neck which had been ongoing for 6 years. On the neck ultrasound imaging, heterogeneous nodules were observed in the parenchyma of
Daily radiological follow-up of swallowed dentures. (a) Day 1: dentures seen in the stomach antrum. (b) Day 2: dentures seen in the jejunum. (c) Day 3: dentures seen in the ileocecal region. (d) Day 5: dentures not observed on the abdominal radiograph.
Foreign bodies in the aerodigestive tract are not an uncommon problem, especially in the paediatric population. However, they are not frequently seen in adults. Foreign bodies that are most commonly seen in the digestive system in adults are chicken and fish bones in Asia and large pieces of food in western countries [
The most common foreign body in adults requiring surgery is a needle, and those causing gastrointestinal perforation (generally, the small intestine) and requiring surgery are fish bones (68% of all foreign bodies causing small intestine perforation).
Dentures which are used as medical prosthetic devices for chewing and for aesthetic reasons or to develop self-confidence are a particular type of foreign body. Aspiration and swallowing of this foreign body is generally seen in patients with psychoneurological deficit, alcohol poisoning, drug overdose, under general anaesthesia, or with maxillofacial trauma. Another significant factor increasing the risk of swallowing dentures is a lack of awareness of the patients of changes in the dentures and incompatibility with the jaw at regular check-up examinations [
Acute impairments of consciousness (craniofacial trauma, stroke, convulsions, and poisoning) increase the risk of tooth aspiration or swallowing and aspiration of the stomach contents. In conscious patients, activities in which dentures could be swallowed or aspiration could occur have been well-documented [
The main contraindication for endoscopic removal of a swallowed prosthesis is evidence of high risk or primary or secondary complications. Foreign bodies affecting the hypopharynx can be removed with hypopharyngoscopy and direct laryngoscopy [
Prostheses affecting the small and large intestines can be removed endoscopically or with surgery (laparotomy or laparoscopy) depending on the size, configuration, risk of intestinal wall perforation, or any complication [
The majority of cases reported in literature have been seen to be the ingestion of partially removable prostheses in particular. However, it has also been reported that when fixed prostheses have been dislodged spontaneously or traumatically, they have been swallowed.
Complications of prosthesis ingestion include necrosis, perforation, penetration of adjacent organs, bleeding, and obstruction. Ulceration and vascular erosion result from digestive system bleeding, and reported cases have shown oesophageal and gastric bleeding caused by a swallowed prosthesis. As the large intestine has a wider diameter and its contents are more solid in texture, these help to prevent trauma to the intestinal wall, and so the entrapment and possible results of an ingested denture are rare. Theoretically, a denture which has passed the ileocecal valve should pass through the large intestine. If it becomes embedded, the only reason for this implantation of the denture can be colonic stenosis such as colon cancer. Several cases have been reported of sigmoid colon perforation [
Dentures are a special type of foreign body requiring the awareness primarily not only of anaesthetists but also of other specialists. Fixed prostheses, especially those which are unstable, are at risk of aspiration and ingestion just as removable prostheses are. Early diagnosis and treatment is of vital importance in the management of swallowed prostheses. Loose, removable dentures, or unstable fixed prostheses must be well evaluated preoperatively. Removable prostheses must be removed before the transfer to the operating theatre. If an unstable, loose fixed prosthesis is noticed, it should be recommended that a dentist is consulted by the anesthetist evaluating the patient.
Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the editor-in-chief of this journal upon request.
The authors have no conflict of interests to declare.
Dzian helped in the study concept, data collection, and surgical therapy for this patient. Akelma and Salık also helped in the study design and writing the paper. Başol conducted the surgical therapy for this patient. Yildırım and Özgün were involved in the data collection. All authors helped in the study concept, study design, writing, data collection, and surgical therapy of the patient.