Primary tooth aspiration during conscious sedation with N2O: foreign body removal with rigid bronchoscopy

Abstract

A 7-year-old girl visited the Samsung Medical Center emergency room for primary tooth aspiration during primary tooth extraction under conscious sedation with N₂O. The patient showed no signs of respiratory complications. Chest radiography and CT revealed a tooth in the right bronchi. Foreign body removal using rigid bronchoscopy was performed on the day of aspiration. With close monitoring of the airway in the pediatric ICU, extubation was performed the next day, and the patient was discharged the same day. The primary objective of this case report was to highlight the potential risk of aspiration associated with the use of N₂O gas for conscious sedation.

Keywords: Aspiration; Conscious Sedation; Foreign Bodies; Removal.

Fig. 1. Chest X-ray demonstrating the presence of the tooth lodged in the right bronchus. No effusion or structural abnormalities are observed. (Yellow triangle: aspirated tooth)

Fig. 2. Chest computed tomography (CT) scan revealed a 1 cm-sized tooth located in the right bronchus intermedius, with no evidence of atelectasis or pneumonitis. (Yellow triangle: aspirated tooth)

Fig. 3. (a) Obscured field of vision resulting from secretion within the bronchus. (b) Exploration following suction to clear the field. (c) Identification of the tooth. (d) Mild swelling observed around the tooth. (e) Tooth extraction performed using forceps. (f) The diameter of the bronchoscope was smaller than that of tooth #54. The otolaryngologist utilized forceps to grasp and extract the tooth via the bronchoscope itself.

Fig. 4. Extracted tooth from the right bronchus of the patient.