Swallowed denture stuck in the proximal esophagus

A 72-year-old male with dementia and Parkinson’s disease presented at the otorhinolaryngology outpatient clinic with acute dysphagia. A chest x‑ray showed a dental prosthesis in the upper esophagus, which was subsequently extracted via rigid esophagoscopy. Due to suspected esophageal perforation on postoperative CT, a cervical approach to the esophagus and flexible esophagoscopy were used, but no evidence of perforation could be identified. This case highlights challenges in managing high-risk esophageal foreign bodies in the upper esophagus, emphasizing the need for careful assessment and a multidisciplinary approach.

Subsequently, rigid esophagoscopy under general anesthesia was scheduled.The denture was situated vertically in the proximal esophagus while one side of the prosthesis was located directly beneath the proximal esophageal sphincter.The mucosa surrounding the prosthesis exhibited signs of inflammation, appearing swollen and vulnerable, probably due to a prolonged impact duration.The dental prosthesis was successfully extracted in its entirety using forceps without any intraoperative objective complications (Fig. 1b), and a nasogastric tube was inserted to alleviate the vulnerable esophagus.A postoperative swallow x-ray test indicated no signs of esophageal perforation; however, there was evidence of aspiration.
Given the escalating levels of laboratory inflammation markers during the postoperative observation period, a thoracic computed tomography (CT) was additionally performed.The imaging revealed soft tissue enlargement dorsal to the thyroid cartilage, indicative of a postoperative hematoma/edema, and a few small air inclusions in the adjacent soft tissue, raising suspicion of a perforation.Furthermore, incipient aspiration pneumonia was also diagnosed on the CT.
Due to the suspected esophageal perforation, a left lateral cervicotomy to the upper esophagus as well as a flexible esophagoscopy were subsequently performed by the thoracic surgery team; however; no evidence of macroscopic perforation could be identified during the procedures.
The postoperative course was regular without complications.After surgery, the patient was fasted and received total parenteral nutrition for support for a period of 6 days.He was then allowed to eat again perorally.Broad-spectrum antibiotic therapy was administered throughout the whole clinical course, resulting in a decline in laboratory inflammatory markers.For This report highlights the challenges in managing high-risk foreign bodies in the upper esophagus.Treatment options for esophageal foreign bodies are flexible esophagoscopy, rigid esophagoscopy, and an open cervical approach.In cases of foreign bodies situated in the upper esophagus as in the present report, rigid esophagoscopy is advised [1].Foreign bodies lodged in the proximal esophagus pose a significantly higher risk of complications compared to those in other locations [2,3].A severe complication is represented by esophageal perforation, which can arise either due to the shape of the foreign body itself or come from manipulation and traction during its extraction.The risk of perforation is elevated in case of prolonged impact duration due to the induced local inflammatory process, older age, and with highrisk objects as attributed to their configuration, dimensions, and material makeup [4][5][6].In our case, all aforementioned risk factors for perforation were present.In the event of suspected esophageal perforation, a contrast swallow x-ray test is recommended to verify the diagnosis.An additional CT can provide further evidence for perforation such as enlargement of the soft tissue of the cervical mediastinum and local air inclusions.In cases of confirmed perforation, an open approach (for cervical perforations primarily a left lateral cervicotomy) is needed [1].In the present case, the immediate postoperative contrast swallow study was negative for perforation.Due to the elevated laboratory inflammation markers, a CT of the neck and thorax was then performed.Based on the suspicion of perforation in the CT scan, a cervicotomy was performed, whereby no perforation could be detected.A further contrast study with thin barium may have ruled out a small perforation, potentially obviating the need for further surgery [1].
Funding Open access funding provided by Medical University of Graz.

Declarations
Conflict of interest M. Habenbacher and A. Andrianakis declares that he has no competing interests.
Ethical standards All information that could be used to potentially identify the patient was removed.
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material.If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Fig. 1 a
Fig. 1 a Chest x-ray showing a radiopaque foreign body shaped like a dental prosthesis in the lower cervical area.b Removed dental prosthesis