Life‐threatening injury caused by complete impalement of a toothbrush: Case report

Abstract

Toothbrushes are the most common cause of foreign body injury to the oral cavity in children, but complete impalement by a toothbrush is an extremely rare occurrence and has not been reported previously. This report describes a 28-month-old girl who fell from a 1m ledge while brushing her teeth. Her toothbrush penetrated the oral cavity and could not be removed, and so she was rushed to the hospital with the toothbrush in place. Contrast-enhanced computed tomography showed penetration of the toothbrush from the oral cavity into and through the right posterior neck at the level of the bifurcation of the common carotid artery. Angiography was performed under general anesthesia, and the toothbrush was removed. In consultation with pediatricians, antibiotic infusion therapy was started, and the patient was extubated on the 5th post-operative day. There were no complications even after eating was resumed, and the patient was discharged on the 13th post-operative day. A toothbrush is an essential item in daily life, but it can cause serious injuries in children in some circumstances.

A forensic evaluation of impalement injuries

“…65,67 Airway obstruction and significant neurological sequelae such as stroke secondary to injury of the carotid artery with subsequent thrombosis may also occur. 68–70…”

“…65,67 Airway obstruction and significant neurological sequelae such as stroke secondary to injury of the carotid artery with subsequent thrombosis may also occur. [68][69][70] Anogenital and perineal impalement trauma in children may be accidental or inflicted. Accidental injuries most often occur when a child is trying to jump over, or on to, an object such as a billiard cue or a bathroom plunger.…”

Mediastinal emphysema induced by minor intraoral toothbrush injury

“…Second, 4–8% of intraoral wounds are reported to develop complications, such as a retropharyngeal abscess 4 or mediastinal emphysema 5 . Furthermore, toothbrush trauma carries a higher risk of infection than other types of oral trauma 3 . This is due not only to the presence of indigenous bacteria in the oral cavity, 6 but also to the attachment of a large number of bacterial colonies, including aerobic and anaerobic bacteria, to the toothbrush itself 7,8 .…”

“…There are two main characteristics of toothbrush trauma. First, because toothbrush injury is a penetrating, intraoral trauma, the injury sometimes spreads to the carotid arteries, veins, intracranial region, and mediastinum, despite minor intraoral findings 3 . Therefore, when a consciousness disorder or cervical findings are observed, evaluation by CT is necessary.…”

“…First, because toothbrush injury is a penetrating, intraoral trauma, the injury sometimes spreads to the carotid arteries, veins, intracranial region, and mediastinum, despite minor intraoral findings. 3 Therefore, when a consciousness disorder or cervical findings are observed, evaluation by CT is necessary. Even if there are no clinical findings at the first visit, follow-up should be performed.…”