Suspicion of tooth aspiration during general anaesthesia in a paediatric patient – a case report

Abstract

Foreign body aspiration or suspicion of it is a serious medical condition, which can cause life-threatening complications, especially in paediatric population. More than 80% of foreign body aspirations occur in children under three years of age. Children are a particularly vulnerable group due to specifi c anatomy of the airway. Symptoms of aspiration vary from suff ocation, coughing to complete absence of symptoms, which is why a diff erential diagnosis between aspiration and ingestion is sometimes very diffi cult. A six-year-old boy was admitted for elective surgery to correct vertical strabismus. At the pre-anaesthesia evaluation, the child was classifi ed as an ASA II patient, due to frequent laryngitis and bronchitis. The Mallampati score was 1 with no wobbly teeth recorded. After anaesthesia induction, the airway was secured with a laryngeal masksize 3.0 without complications. Upon awakening of the patient and removal of the laryngeal mask, blood was observed in the lodge of the lower left incisor and a lack thereof. The patient was without signs of respiratory distress. An emergency chest X-ray ruled out a foreign body in the airway, and subsequent X-rays of the abdomen revealed the presence of teeth in the projection of the stomach. The child was discharged to home care without complications. The clinical picture of foreign body aspiration under anaesthesia may be atypical and asymptomatic. Therefore, even the slightest suspicion of aspiration, especially in anaesthesia procedures, should be ruled out or confi rmed. Complications are most often the result of late-recognized aspiration.