Читать книгу Management of Complications in Oral and Maxillofacial Surgery - Группа авторов - Страница 92

Aspiration of a dental implant or implant components is one of the possible complications during implant placement. Coughing, choking, wheezing, and hoarseness, chest pain, and shortness of breath are the signs and symptoms of respiratory distress secondary to aspiration, and this represents a medical emergency. In such cases, basic life support should begin immediately, and patient monitors should be applied including noninvasive blood pressure monitoring, pulse oximetry, three‐lead electrocardiogram, end‐tidal carbon dioxide monitoring, and supplemental oxygen; endotracheal intubation could be considered to secure the airway in extreme circumstances. Some authors have described the use of simple finger sweep technique to remove the aspirated material, but only if the implant or foreign body is visible in the oral cavity, or else further displacement into the airway may result. If accidental ingestion is suspected, the Heimlich maneuver should be performed and the patient should be placed on supplemental oxygen, if necessary. If an aspirated implant or implant component can be visualized, an attempt at removal can be made with the use of Magill forceps and laryngoscope. If there is a decline in oxygen saturation, endotracheal intubation or emergent surgical cricothyroidotomy may be indicated [29]. In most cases of aspiration, the foreign body (dental implant) becomes lodged in the right mainstem bronchus due to the more vertical course from the trachea, as well as its greater diameter compared to the left mainstem bronchus. A chest X‐ray must be obtained to confirm the location of an aspirated object, and this will likely include a visit to the Emergency Department. Once confirmed that the implant has been aspirated, appropriate consultations should occur with respiratory therapy or pulmonology and bronchoscopy should be carried out urgently to retrieve the implant.