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Abbreviated case report
Abbreviated casereport Foreign
bodies
of dental
origin
in the esophagus
Miklds Seabo’, Imre Szabo’, and L6sxld Buris, Debrecen, Hungary INSTITUTE
OF FORENSIC
(DIRECTOR
: PROF.
MEDICINE,
DR. JiNOS
UNIVERSITY
MEDICAL
SCHOOL
NAGY)
Two unusual cases are presented. In one the presence of plaster impression material in the esophagus resulted in the patient’s death. In the other case, a portion of a broken dental prosthesis became lodged in the esophagus, with fatal consequences.
T
he entrance of dental materials and appliances into the esophagus is rare.lM5 Therefore, we believe that the two cases that follow are of special interest. CASE REPORT CASE
1
On April 21, 1967, an impression was taken of the upper arch of a 73-year-old woman. The dentist reported that after taking the impression he removed the visible pieces of plaster from the mouth and dismissed the patient. She returned 2 hours later, stating that she was unable to eat her lunch because of nausea and dysphagia. The dentist re-examined the patient to determine whether remnants of the impression material (plaster of Paris) remained in the mouth or pharynx. Finding none, he again dismissed her. The complaints did not cease and, upon awaking the following morning, the patient felt quite ill. An ambulance was called and, in the presence of the ambulance doctor, the patient died. Autopsy
report
Examination revealed the body of an elderly woman of medium development and nutrition. There was a complete lack of teeth. Hemorrhagic petechiae were seen on the oral mucosa. The lumen of the esophagus was occluded at the height of the thyroid cartilage by a solid 2 by 1.5 cm. piece of plaster of Paris, colored grayish white with a tinge of light scarlet red. The piece of plaster had ulcerated an area of the mucous membrane as large as a 50 tiller coin. Around the plaster at the orifice of the larynx, a small amount of macerated meat was observed (Fig. 1). Similar fragments of meat were found in the trachea and the bronchial system, occluding some secondary bronchial tubes. Emphysema, pulmonary edema, bronchopneumonia on the inferior lobes, cerebralsclerosis, coronary sclerosis, nephrosclerosis, myocardial degeneration, congested viscera, and uterine myoma were encountered. The histologic examination confirmed the macroscopic Culings.
196
Volume Number
34 2
Abbreviated
case report
197
CASE 2
A 57-year-old male patient in a nursing home for mental patients suddenly became ill on Jan. 6, 1967. He complained of a headache and was running a high temperature, and a pink purulent material was draining from his nostrils and mouth. No history of his having swallowed a foreign body was obtained. Despite the administration of antibiotics, the patient died the next day. Autopsy
report
Postmortem examination revealed the corpse of a man of medium development and nutrition. The upper arch was edentulous, and only two teeth remained in the lower arch. Part of a broken dental prosthesis was present in the oral cavity. Inside the esophagus, lodged on the orifice of the larynx, the other part of the broken prosthesis was found. It was located in an oblique position, with the upper border lodged between the hyoid bone and the thyroid cartilage. The lower border was wedged into the piriform fossa and had produced an ulceration of the mucous membrane (Fig. 2). In addition to these findings, encephalomalacia, cerebral sclerosis, coronary sclerosis, nephrosclerosis, and bronchopneumonia were found. The histologic examination indicated purulent pneumonia. The onset of the inflammatory process could be inferred as beginning 5 to 6 days prior to death. On the other hand, the degree of ulceration of the mucous membrane corresponded to a period of only a few hours.
SUMMARY We have described two cases in which we conducted postmortem examinations. In the first case the esophagus was occluded by a piece of plaster dental impression material swallowed while an impression for a dental prosthesis was being taken. Death resulted from pneumonia due to aspiration. In the second
198
Szabo’, Szab15, and
Oral Surg. August, 1972
Buris
Fig.
2
case the swallowed part of the denture broken by the helpless patient became caught in the orifice of the larynx and aggravated the patient’s state of health. REFERENCES
1. Daucher, E. : Erstickungstod durch Fremdkorperaspiration. Kriminalistik 21: 478-479, 1967. 2. Kellerhals, B. : bsophagusfremdkiirper : Itiologische, diagnostische und therapeutische Probleme. Z. Laryngol. Rhinol. Otol. 49: 526-533, 1970. 3. Markbczy, E.: Lenyelt es a nyelScsSben fennakadt reszleges fogp6tlas sorsa, Fogorv. Sz. 37: 57-60, 1944. 4. Porges, P., and Sljus, N.: Verlegung der Atemwege durch einen FremdkSrper, Anaesthesist 18: 373, 1969. 5. Weyrich, G.: Ein besonderer Fall von plb;tzlichen Tod durch Erstickung; Aspiratio des Gummisiiugers eines Oberkieferzahnprothese, Beitr. Gerichtl. Med. 14: 194-196, 1938. Reprint requests to: Dr. Miklds Szab6 Rendiirorvosi Hivatal GyCr, Hungary
bodies
of dental
origin
in the esophagus
Miklds Seabo’, Imre Szabo’, and L6sxld Buris, Debrecen, Hungary INSTITUTE
OF FORENSIC
(DIRECTOR
: PROF.
MEDICINE,
DR. JiNOS
UNIVERSITY
MEDICAL
SCHOOL
NAGY)
Two unusual cases are presented. In one the presence of plaster impression material in the esophagus resulted in the patient’s death. In the other case, a portion of a broken dental prosthesis became lodged in the esophagus, with fatal consequences.
T
he entrance of dental materials and appliances into the esophagus is rare.lM5 Therefore, we believe that the two cases that follow are of special interest. CASE REPORT CASE
1
On April 21, 1967, an impression was taken of the upper arch of a 73-year-old woman. The dentist reported that after taking the impression he removed the visible pieces of plaster from the mouth and dismissed the patient. She returned 2 hours later, stating that she was unable to eat her lunch because of nausea and dysphagia. The dentist re-examined the patient to determine whether remnants of the impression material (plaster of Paris) remained in the mouth or pharynx. Finding none, he again dismissed her. The complaints did not cease and, upon awaking the following morning, the patient felt quite ill. An ambulance was called and, in the presence of the ambulance doctor, the patient died. Autopsy
report
Examination revealed the body of an elderly woman of medium development and nutrition. There was a complete lack of teeth. Hemorrhagic petechiae were seen on the oral mucosa. The lumen of the esophagus was occluded at the height of the thyroid cartilage by a solid 2 by 1.5 cm. piece of plaster of Paris, colored grayish white with a tinge of light scarlet red. The piece of plaster had ulcerated an area of the mucous membrane as large as a 50 tiller coin. Around the plaster at the orifice of the larynx, a small amount of macerated meat was observed (Fig. 1). Similar fragments of meat were found in the trachea and the bronchial system, occluding some secondary bronchial tubes. Emphysema, pulmonary edema, bronchopneumonia on the inferior lobes, cerebralsclerosis, coronary sclerosis, nephrosclerosis, myocardial degeneration, congested viscera, and uterine myoma were encountered. The histologic examination confirmed the macroscopic Culings.
196
Volume Number
34 2
Abbreviated
case report
197
CASE 2
A 57-year-old male patient in a nursing home for mental patients suddenly became ill on Jan. 6, 1967. He complained of a headache and was running a high temperature, and a pink purulent material was draining from his nostrils and mouth. No history of his having swallowed a foreign body was obtained. Despite the administration of antibiotics, the patient died the next day. Autopsy
report
Postmortem examination revealed the corpse of a man of medium development and nutrition. The upper arch was edentulous, and only two teeth remained in the lower arch. Part of a broken dental prosthesis was present in the oral cavity. Inside the esophagus, lodged on the orifice of the larynx, the other part of the broken prosthesis was found. It was located in an oblique position, with the upper border lodged between the hyoid bone and the thyroid cartilage. The lower border was wedged into the piriform fossa and had produced an ulceration of the mucous membrane (Fig. 2). In addition to these findings, encephalomalacia, cerebral sclerosis, coronary sclerosis, nephrosclerosis, and bronchopneumonia were found. The histologic examination indicated purulent pneumonia. The onset of the inflammatory process could be inferred as beginning 5 to 6 days prior to death. On the other hand, the degree of ulceration of the mucous membrane corresponded to a period of only a few hours.
SUMMARY We have described two cases in which we conducted postmortem examinations. In the first case the esophagus was occluded by a piece of plaster dental impression material swallowed while an impression for a dental prosthesis was being taken. Death resulted from pneumonia due to aspiration. In the second
198
Szabo’, Szab15, and
Oral Surg. August, 1972
Buris
Fig.
2
case the swallowed part of the denture broken by the helpless patient became caught in the orifice of the larynx and aggravated the patient’s state of health. REFERENCES
1. Daucher, E. : Erstickungstod durch Fremdkorperaspiration. Kriminalistik 21: 478-479, 1967. 2. Kellerhals, B. : bsophagusfremdkiirper : Itiologische, diagnostische und therapeutische Probleme. Z. Laryngol. Rhinol. Otol. 49: 526-533, 1970. 3. Markbczy, E.: Lenyelt es a nyelScsSben fennakadt reszleges fogp6tlas sorsa, Fogorv. Sz. 37: 57-60, 1944. 4. Porges, P., and Sljus, N.: Verlegung der Atemwege durch einen FremdkSrper, Anaesthesist 18: 373, 1969. 5. Weyrich, G.: Ein besonderer Fall von plb;tzlichen Tod durch Erstickung; Aspiratio des Gummisiiugers eines Oberkieferzahnprothese, Beitr. Gerichtl. Med. 14: 194-196, 1938. Reprint requests to: Dr. Miklds Szab6 Rendiirorvosi Hivatal GyCr, Hungary