Dental News - Dentures discovered in larynx days after general anaesthetic

Dental Tribune International

Mon. 26. August 2019

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GREAT YARMOUTH, UK: Dentures need to be taken out before a general anaesthetic is administered, doctors have warned after a 72-year-old man’s dentures became stuck in his throat during surgery to remove a harmless lump in his abdominal wall. They were not discovered for eight days. Aside from causing the patient considerable pain, bleeding and difficulty swallowing, the oversight led to repeated hospital visits, additional invasive tests, blood transfusions and, eventually, more surgery.

Dr Harriet Cunniffe, an otolaryngologist at James Paget University Hospitals NHS Foundation Trust in Great Yarmouth and author of the case study, describes how, six days after abdominal surgery, the patient sought emergency medical care at a hospital. He complained of blood in the mouth, difficulty swallowing and pain. These symptoms had prevented him from eating solid food since the operation. Nothing in his test results prompted doctors to consider anything other than a respiratory infection and the side effects of having had a tube down his throat during the operation. He was therefore prescribed mouthwash, antibiotics and steroids, and was sent home.

Two days later, he returned with worsening symptoms. He had been unable to swallow any of the medication he had been prescribed. He was admitted to hospital with suspected aspiration pneumonia—a severe chest infection usually caused by inhaling food, stomach acid or saliva into the lungs. During this hospital stay, a diagnostic procedure to look at his throat and larynx revealed a semi-circular object lying across his vocal cords. This had clearly caused internal swelling and blistering.

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When this was explained to him, the man revealed that his dentures had been lost during his initial hospital stay. He then had emergency surgery to remove the dentures and was discharged after six days. But six days later, a bout of bleeding prompted his return. When tests revealed the bleeding had stopped, he was sent home, only to reappear ten days later with the same problem.

After a couple of days, he was again discharged but returned six days later because of further bleeding. Tests revealed that he had internal wound tissue around the site of the blistering, which was then cauterised to prevent further bleeding. Because he had lost so much blood, he also required a blood transfusion. He was discharged after two days, but returned again nine days later with further bleeding, which required emergency surgery, as the source of the bleed was found to be a torn artery near the wound.

A check-up a week after this procedure showed that the tissue was healing well. He did not need further emergency care and after six weeks his blood count was found to be normal. Cunniffe notes that this is not the first documented case of dentures being inhaled while anaesthetic is being infused.

“There are no set national guidelines on how dentures should be managed during anaesthesia, but it is known that leaving dentures in during bag-mask ventilation allows for a better seal during induction, and therefore many hospitals allow dentures to be removed immediately before intubation,” she wrote.

The presence of any dentures or dental plates should be clearly documented before and after any surgical procedure, and all members of the surgical team should be made aware of what is to be done with them, Cunniffe added.

The case study, titled “Dentures discovered in larynx 8 days after general anaesthetic”, was published on 12 August 2019 in BMJ Case Reports.

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After Anaesthetic Days Dentures Discovered Général In Larynx

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