Foreign Bodies Caused by Dental Treatment in the Head and Neck - A Surgical Challenge

Abstract

Study Design Case seriesObjective: By reporting several cases of dislocated foreign bodies, we aim to make dentists/surgeons aware of possible severe and potentially life-threatening complications. In case of dislocation, the appropriate radiological assessment depending on the foreign body is required if direct removal fails.Material and Methods: Electronic and paper record of patients suffering from various dental foreign bodies were analysed. Analysis included history of dislocation, type of foreign object, anatomical region of dislocation, related dental treatment and approach to surgical removal. Results: In total, 5 patients with various dental foreign body objects, including fractured root canal instruments (n = 2), a broken dental injection needle (n = 1), a broken Lindemann bur (n = 1) and root filling material (n = 1) are reported. Patient ages ranged from 14 to 54 years. In 4 cases, the foreign body could be salvaged successfully, and one patient refused the surgical therapy. General anaesthesia was required in 4 patients. Intraoperatively, a 3D C-arm was used in 3 cases to ensure the successful recovery of the foreign bodies. In 1 case, the foreign body could be removed with endoscopical assistance. Conclusion:The management of dental materials and instruments requires diligent care by the practitioner, and prevention techniques should be used at all times to minimise the patients' risk. In the case of foreign body dislocation, appropriate radiological assessment and determination of further medical treatment (if necessary) should take place. During surgical procedures, intraoperative 3D-imaging, as well as endoscopic techniques, are helpful tools to ensure the recovery of foreign bodies.

Instrument fracture in periodontal therapy: ethical disclosure and clinical management - a case report

“…In this particular case, a curved artery forceps was selected for its suitability for the intended task. Utilization of X-rays, MRIs, CT scans or metal detectors have been suggested in the literature to aid in the navigation of the broken fragment to minimize potential risk of damaging critical anatomical structures [ 33 , 34 ]. Aperi-apical radiograph aided in accurately localizing the broken fragment in this case, which was then retrieved by curved artery forceps after creating a pathway by deflecting gingiva.…”

Surgical Removal of an Orthodontic Mini-Screw Displaced Into the Lateral Pharyngeal Space: A Case Report and Review of Pertinent Literature

“…Dislodgement of foreign bodies into the soft tissues of the head and neck region is a complication, which may occur in patients of all age groups and could be due to various causes [ 4 ]. In most cases, they are either traumatic in origin, such as after road traffic accidents, gunshot wounds, shrapnel from explosives, and industrial accidents, or they could be iatrogenic, such as broken medical instruments, dental local anesthetic needles and dislodged implants [ 7 ].…”

“…It is not uncommon for maxillofacial surgeons to deal with foreign bodies, which are displaced into the oral cavity soft tissues, maxillary sinuses, the neck spaces, or any other adjoining anatomical structures of the head and neck area [ 4 ]. The head and neck region is anatomically complex and comprises several intricate and sensitive anatomical structures, including cranial nerves, major blood vessels, the aero-digestive tracts, and the auditory and visual apparatuses [ 5 ].…”

“…These are classified into four main subtypes: (1) Fascial spaces of the face - canine, buccal, parotid, infratemporal, and masticatory (masseteric, pterygomandibular, temporal); (2) Suprahyoid fascial spaces - sublingual, submental, submandibular, lateral pharyngeal/parapharyngeal, and peritonsillar; (3) Infrahyoid fascial spaces - pretracheal and paratracheal; (4) Fascial spaces of the neck - retropharyngeal, prevertebral (danger space), and carotid sheath [ 8 ]. Oral surgical and dental procedures in the posterior mandibular area such as local anesthetic injection, extraction of lower third molars, insertion of screws in the retromolar area, or dental implant placement can predispose to the inadvertent displacement of foreign bodies (teeth or implants) into three main fascial spaces: pterygomandibular space, submandibular space, or lateral pharyngeal space [ 4 ]. The pterygomandibular space is bounded anteriorly by the anterior border of the mandibular ramus and the pterygomandibular raphe.…”

“…Most cases of foreign body displacement associated with dental or oral surgical treatment in the posterior mandible are reported in the pterygomandibular and submandibular spaces, owing to their anatomic proximity to the mandible [ 4 ]. Foreign body displacement to the lateral pharyngeal space occurs rarely and is predominantly due to deeper migration of a dislodged foreign body, left in situ in one of the superficial anatomic spaces, and occurs because of jaw movements [ 9 ].…”