口腔疾病防治 ›› 2022, Vol. 30 ›› Issue (8): 582-587.DOI: 10.12016/j.issn.2096-1456.2022.08.008

• 防治实践 • 上一篇    下一篇

口腔种植术中误吸螺丝刀病例报道及文献回顾

武霖(), 孔繁芝, 钱良玉, 仇晨光, 孙洪涛, 佘鹏()   

  1. 江苏大学附属人民医院口腔科,江苏 镇江(212000)
  • 收稿日期:2021-12-01 修回日期:2022-02-27 出版日期:2022-08-20 发布日期:2022-05-09
  • 通讯作者: 佘鹏
  • 作者简介:武霖,主治医师,博士,Email: 61802169@qq.com
  • 基金资助:
    镇江市重点研发计划(社会发展)项目(SH2019060)

Screwdriver aspiration during implant surgery: case report and literature review

WU Lin(), KONG Fanzhi, QIAN Liangyu, QIU Chenguang, SUN Hongtao, SHE Peng()   

  1. Department of Stomatology, Affiliated People's Hospital of Jiangsu University, Zhenjiang 212000, China
  • Received:2021-12-01 Revised:2022-02-27 Online:2022-08-20 Published:2022-05-09
  • Contact: SHE Peng
  • Supported by:
    Key Research and Development Program of Zhenjiang City(SH2019060)

摘要:

目的 探讨口腔诊疗操作中误吸、误吞的预防措施与治疗方法。方法 报道1例种植术中发生误吸的病例,并结合相关口腔诊疗操作中误吸、误吞的文献进行复习。结果 该患者行种植义齿修复时,螺丝刀不慎掉落至口中,伴随轻微咳嗽2次。手术医生及助手立即停止操作,于患者口中未寻及。患者无呼吸不畅、胸闷、气短等不适。胃镜检查未见异物,胸部X线与CT检查示左肺下叶金属致密影。局部麻醉下,呼吸内科医生使用支气管镜及配套活检钳夹取异物。取出异物后患者无明显不适,仅有轻微咳嗽,给予口服头孢氨苄、甲硝唑3 d预防感染。文献表明,口腔诊疗操作中发生误吸后应立即停止操作、放平椅位,预防异物进一步下行增加取出难度及造成消化道呼吸道损伤。通过影像学检查确定异物位置,选择相应的手段取出异物。结论 口腔诊疗操作中发生误吸、误吞后患者可能无明显不适症状,需要通过影像学检查明确异物位置后取出异物。

关键词: 误吸, 误吞, 异物, 修复, 义齿, 种植牙手术, 支气管镜, 影像学检查, 螺丝刀

Abstract:

Objective To discuss and summarize the preventive measures and treatment methods for aspiration/ingestion during dental procedures. Methods One case of aspiration during an implant operation was reported, and the literature on aspiration/ingestion during oral procedures was reviewed. Results An implant screwdriver accidentally slipped into the mouth of the patient during implant surgery. The patient experienced no obvious discomfort except a few coughs. The surgeon and assistant paused the procedure immediately to search for the screwdriver, but it was not found. The patient declared that there was no special abnormality, such as breathing disorder or chest distress, so we considered that the foreign body was ingestion. After the implant surgery was completed, no foreign body was found in the stomach via gastroscopy. Chest X-ray and CT showed a dense metal shadow in the lower lobe of the left lung. Under local anesthesia, bronchoscopy and biopsy forceps were used by respiratory physicians to clip out the foreign body. After removal of the foreign body, the patient had no obvious discomfort but a slight cough. Cephalexin and metronidazole were given for three days to prevent infection. Three days later, the patient had no complaints of respiratory discomfort. After reviewing the literature, we found that the operation should be paused immediately after aspiration/ingestion occurs during dental procedures and that the dental chair should be laid down to prevent the foreign body from descending deeper, which may increase the difficulty of removal and cause gastrointestinal and respiratory tract injury. The position of the foreign body should be determined by imaging examination, and the corresponding means to remove the foreign body should be performed. Conclusion Patients may have no obvious symptoms after aspiration/ingestion during dental procedures, and the foreign body can be removed after imaging examination.

Key words: aspiration, ingestion, foreign body, prosthodontics, denture, implanting surgery, bronchoscope, imaging examination, screwdriver

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