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 Table of Contents  
CASE REPORT
Year : 2017  |  Volume : 29  |  Issue : 1  |  Page : 67-69

Lost and found…Tracking a swallowed denture: Role of radiology


1 Department of Oral Medicine and Radiology, Annasaheb Chudaman Patil Memorial Dental College, Dhule, Maharashtra, India
2 Department of Orthodontics, Annasaheb Chudaman Patil Memorial Dental College, Dhule, Maharashtra, India

Date of Submission08-Jun-2016
Date of Acceptance01-Feb-2017
Date of Web Publication04-Aug-2017

Correspondence Address:
Yogita Khalekar
Department of Oral Medicine and Radiology, Annasaheb Chudaman Patil Memorial Dental College, Dhule, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaomr.JIAOMR_66_16

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   Abstract 

Denture ingestion or aspiration is a problem requiring awareness of different specialists including dentists, surgeons, otolaryngologists, and anesthesiologists for prevention, early diagnosis and adequate treatment. Complications of swallowed dentures include hollow viscous necrosis, perforation, and penetration to neighbouring organs leading to fistulae, bleeding and obstruction. Here, we present the case of a 65 year old female patient who swallowed the denture, which was detected by barium swallow and removed by endoscopy. Hence, the management of swallowed denture needs a multidisciplinary approach with the help of a dentist, otolaryngologist and anesthesiologists. Dentists should recommend patients to visit them for planned check ups or revisit them in case of denture dislodgement or loosening as soon as possible to prevent such life threatening events.

Keywords: Denture, endoscopy, fistulae, necrosis, otolaryngologist


How to cite this article:
Khalekar Y, Zope A, Saxena S, Shah K. Lost and found…Tracking a swallowed denture: Role of radiology. J Indian Acad Oral Med Radiol 2017;29:67-9

How to cite this URL:
Khalekar Y, Zope A, Saxena S, Shah K. Lost and found…Tracking a swallowed denture: Role of radiology. J Indian Acad Oral Med Radiol [serial online] 2017 [cited 2019 Nov 21];29:67-9. Available from: http://www.jiaomr.in/text.asp?2017/29/1/67/212090


   Introduction Top


The problem of inhaled or swallowed dentures is a multidisciplinary problem which concerns surgery, dentistry, endoscopy, otolaryngology, anesthesiology, psychiatry, neurology, thoracic surgery and emergency medicine. From the viewpoint of surgeons, anesthesiologists, and otolaryngologists, inhaled or ingested denture is a foreign body of respiratory or gastrointestinal tract. From a dentists’ viewpoint, aspiration and ingestion are complications of dentures. This makes swallowed dentures a special kind of foreign body distinct from needles, coins, batteries, etc.[1] Approximately 80% of all ingested foreign bodies pass out through the entire gastrointestinal tract spontaneously and 20% of them can impact at different levels of gastrointestinal tract.[2] The most common site of impaction of ingested denture is the esophagus.[3]


   Case Report Top


A 63-year-old female presented with complaint of accidentally swallowing her denture while taking her oral hypoglycemic medication at night. She provided a history of ill-fitting denture since few weeks. Upon swallowing her medication with water, she felt a give away feeling of the denture and could sense the denture moving down her throat and later felt discomfort at her anterior chest. There was mild throat discomfort, no shortness of breath, and no airway compromise was noted.

On examination, she was having dysphagia and pooling of saliva in both pyriform fossae. Her vital signs were stable. Oral cavity examination revealed no residual remnant of the said dislodged denture [Figure 1], no bleeding from the denture site, no mucosal tear, or any foreign body. Lungs air entry was equal bilaterally. An urgent barium swallow was performed because most of the dentures are radiographically translucent and may be missed by routine plain chest X-ray. It demonstrated the presence of the denture in the postcricoidal region [Figure 2]. A direct laryngoscopy and esophagscopy were performed under general anesthesia. The denture was found lodged within the thoracic esophagus. Denture was removed easily on a single attempt without any trauma to the mucosa using forceps [Figure 3]. Post removal, there was slight superficial mucosal abrasions at the impacted denture site.
Figure 1: Edentulous space

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Figure 2: Presence of the denture in the postcricoidal region

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Figure 3: Denture retrieved by endoscopy

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Patient was kept under observation overnight post procedure. Postoperatively, she was able to tolerate orally, with no dysphagia, odynophagia, or mediastinitis symptoms. She was well and afebrile. The patient was discharged the next day.


   Discussion Top


When a foreign object, such as a denture, is accidently aspirated or ingested, its early detection, location and removal is essential. Any object which passes into and remains in the esophagus in the worst scenario can prove fatal when aspirated. Death may also be caused by infectious processes secondary to the embedded foreign body, general debilitation, aortic perforation, or the very act of removal itself.[4] Ingestion of a denture can be a frightening and painful experience for the patient, and hence, the emergency medical intervention is mandatory.

Foreign body aspiration and ingestion is mostly encountered among patients with psychoneurological deficit, alcohol intoxication, drug overdose, general anesthesia and maxillofacial trauma. Completely edentulous or partially edentulous people are also at higher risk of foreign body ingestion including dentures because of reduced sensation of the oral mucosa and poor motor control of laryngopharynx. Another important issue increasing the risk of denture ingestion is the lack of patient awareness regarding the need for regular check-ups and denture change or compliance.[1] For example, in our case, the patient had complained of ill fitting denture, but due to lack of awareness about its hazards she ignored it.

There are life threatening complications caused by swallowed dentures [Table 1]. Treatment varies according to site of impactions and the clinical signs and symptoms.[5],[6],[7],[8],[9],[10],[11],[12] Three modalities of management are available: Observation (wait and watch), endoscopy, and surgery. Observation is possible only in cases when the dimensions of ingested denture are small and the configuration does not assume trauma of the gastrointestinal tract.[1] Endoscopy is the modality of choice but is not always possible. The main contraindication for the endoscopic removal of the ingested denture is a high risk or the evidence of primary and secondary complications. Dentures impacted in the esophagus can also be successfully removed endoscopically – either by rigid or by flexible esophagoscopy;[7],[13] however, its failure or emerging complications are indications for open surgery: Transcervical esophagotomy, transthoracic esophagotomy, or esophagectomy.[7]
Table 1: Complications caused by swallowed dentures


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The gold standard for dentures impacted in the upper gastrointestinal tract without any complications is endoscopy; however, in complicated cases surgery is inevitable. For dentures impacted in the lower gastrointestinal tract in uncomplicated cases the most common strategy seems to be observation (wait and watch), and for complicated cases, surgery is warranted. Overall, the success of the treatment of denture ingestion is early diagnosis, prompt and proper decision-making, and initiation of treatment without any delay.[1]


   Conclusion Top


The management of swallowed denture needs a multidisciplinary approach with the help of dentist, otolaryngologist, and anesthesiologist. Dentists should recommend patients to visit them for planned check-ups or revisit them in case of denture dislodgement or loosening as soon as possible to prevent such life threatening events.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Gachabayov M, Isaev M, Orujova L, Isaev E, Yaskin E, Neronov D. Swallowed dentures: Two cases and a review. Ann Med Surg 2015;4:407-13.  Back to cited text no. 1
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2.
Webb WA. Management of foreign bodies of the upper gastrointestinal tract: Update. Gastrointest Endosc 1995;41:39-51.  Back to cited text no. 2
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3.
Nandi P, Ong GB. Foreign body in the esophagus: Review of 2394 cases. Br J Surg 1978;65:5-9.  Back to cited text no. 3
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4.
Mohamad I, Devi B, Adilah N, Othman N. The swallowed dentures. J Dent 2014;4:621-3.  Back to cited text no. 4
    
5.
Sharma RC, Dogra SS, Mahajan VK. Oro-pharyngo-laryngeal foreign bodies: Some interesting cases. Indian J Otolaryngol Head Neck Surg 2012;64:197-200.  Back to cited text no. 5
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6.
Singh B, Kantu M, Har-El G, Lucente FE. Complications associated with 327 foreign bodies of the pharynx, larynx and esophagus. Ann Otol Rhinol Laryngol 1997;106:301-4.  Back to cited text no. 6
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7.
Bandyopadhyay SN, Das S, Das SK, Mandal A. Impacted dentures in the oesophagus. J Laryngol Otol 2014;128:468-74.  Back to cited text no. 7
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8.
Singh P, Singh A, Kant P, Zonunsanga B, Kuka AS. An impacted denture in the oesophagus- An endoscopic or a surgical emergency- A case report. J Clin Diagn Res 2013;7:919-20.  Back to cited text no. 8
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9.
Neustein S, Beicke M. Ingestion of a fixed partial denture during general anesthesia. Anesth Prog 2007;54:50-1.  Back to cited text no. 9
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10.
Furihata M, Tagaya N, Furihata T, Kubota K. Laparoscopic removal of an intragastric foreign body with endoscopic assistance. Surg Laparosc Endosc Percutan Tech 2004;14:234-7.  Back to cited text no. 10
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11.
Abe K, Miki A, Okamura T, Shimada K, Yamamoto T, Aiso M, et al. Endoscopic removal of a denture with clasps impacted in the ileocecum. Clin J Gastroenterol 2014;7:506-9.  Back to cited text no. 11
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12.
Segall MM, Klein SN, Bradley GT. Colonoscopic extraction of dentures. Gastrointest Endosc 1983;29:142-3.  Back to cited text no. 12
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13.
Okugbo S, Onyeagwara N. Oesophageal impacted dentures at the University of Benin Teaching Hospital, Benin city, Nigeria. J West Afr Coll Surg 2012;2:102e111.  Back to cited text no. 13
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    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1]



 

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