Severe Craniofacial Trauma and Foreign Bodies (Teeth) in Tracheobronchial Tree

Abstract

A 51-year-old male patient with severe blunt facial trauma secondary to an assault was brought to the emergency room. At arrival, the Glasgow Coma Scale (GCS) provided a score of eight points. On physical examination, the patient showed severe facial trauma with epistaxis and multiple blunt wounds in forehead, left maxillary region, left eyelid, and lower lips. Mandible showed evidence of midline fracture and a missing incisor tooth. The patient was immediately intubated, and mechanical ventilation was initiated. A head CT scan revealed left ventricular collapse and mild midline right deviation due to hemispheric edema. No subdural or epidural hematoma was present. Tridimensional reconstruction showed multiple left zygomatic fractures and complete midline fracture and diastases on the mandible as well as missing tooth (Fig. 1a). Chest X-rays showed 8th and 9th left ribs fractured plus two images in the right lung suggesting the presence of foreign bodies, one of them clearly a tooth (Fig. 1b). Patient was hospitalized in the Neuroscience Unit, and intracranial pressure (ICP) was monitored with a fiberoptic device. On the day after arrival, the patient showed a more stable condition, therefore, a flexible bronchoscopy was performed to rule out the presence of foreign bodies in the tracheobronchial tree.