Читать книгу Management of Complications in Oral and Maxillofacial Surgery - Группа авторов - Страница 70

 Etiology: no or inappropriate use of pharyngeal packs/screens

 Management: suction, Heimlich maneuver, laryngoscopy, bronchoscopy

The incidence of foreign body, or tooth, aspiration or ingestion is likely underreported in the literature. Approximately 92.5% of objects are ingested, while the remaining 7.5% are aspirated [3, 4]. Patients undergoing the surgical removal of third molars are often sedated, resulting in their gag and cough reflexes being obtunded. A pharyngeal curtain should be utilized in all patients to prevent aspiration or ingestion during surgery. If the patient is not coughing or in any respiratory distress, it is likely the tooth has been ingested and prompt referral to an emergency room for abdominal and chest radiographs to confirm the location of the object should be made. Coughing that continues or leads to respiratory distress should alert the surgeon to probable aspiration. An attempt to suction the object from the oral pharynx should be made and basic life support (BLS) and, if necessary, advanced cardiac life support (ACLS) protocols activated. The Heimlich maneuver should be used to attempt to dislodge the object. If a patient becomes cyanotic or unconscious, an attempt at retrieval under direct laryngoscopy can be made, if the surgeon's office has the necessary equipment. If this fails, emergent cricothyrotomy may be necessary to secure the airway. An object that passes through the vocal chords will most likely end up in the right main stem bronchus or right lung (right mainstem bronchus has a more vertical takeoff from the trachea than the left side), and the patient should be transported to the emergency room and arrangements should be made for bronchoscopy for object retrieval by an experienced clinician (Figure 2.8).

Fig. 2.8. Chest X‐ray demonstrating aspiration of a tooth.