Dental Prothesis in Supraglottis

An 82-year-old woman with a history of hypertension presented to the emergency department with 10 days of illness characterized by foreign body sensation, odynophagia, and dysphonia after dental prosthesis placement. Neck X-ray showed the presence of a radiopaque foreign body at the laryngeal level (Figure 1). During flexible laryngoscopy, the presence of a metal dental prosthesis between the hypopharynx and left supraglottis was observed, with metal inlay and abundant secretions (Figure 2). An extraction of the foreign body in the operating room was scheduled; but during preparation, the patient had a non-ST-segment elevation myocardial infarct, so her surgery was rescheduled. A week later, in coordination with the anesthesiology and cardiology departments, the patient underwent foreign body removal under sedation. There were no further complications.

Figure 1.

X-ray neck, anteroposterior (A) and lateral (B) view. Radiopaque foreign body in superior airway.

Figure 2.

Flexible laryngoscopy. Metal dental prothesis impacted in the hypopharynx and left supraglottis, abundant secretions.

Foreign body is an emergency that may cause fatal complications. It is more common in children, but older adults are also susceptible. ¹ People of this age-group may be at risk due to poor coordination of swallowing, altered glottic closure, or inadequate cough reflex. ² Symptoms may vary according to foreign body characteristics and site of impactation, from mild dysphonia to an airway emergency. ³ In this case, the patient presented with a foreign body impacted in supraglottis, without dyspnea; but it may have elicited vagal stimulation and contributed to myocardial infarction. Due to potential hemodynamic compromise and in the absence of respiratory symptoms, extraction was delayed.