Emergency extraction of accidental impacted upper denture in the Association of American Anesthesiologist IV elderly patient: A case report and review of literature

Abstract

A 78-year-old retired civil servant being managed for hypertensive heart disease and combined mixed cardiac valvular diseases (aortic stenosis and incompetence, mitral stenosis and incompetence), who has been on routine medication, accidentally swallowed his upper denture during the process of his medication. He presented to the private ENT hospital about 2 h post-ingestion. His other complaints were throat pain, dysphagia, and odynophagia. Clinical examination revealed an elderly man in painful distress and anxious looking. The throat and neck examination revealed tenderness at the level of the 6th cervical vertebrae and on the right side with some pooling of saliva in the throat. The oral cavity also revealed missing upper incisor tooth. His cardiovascular system revealed his apex beat at the 7th left intercostal space, heaving with irregular heart sounds and mixed beats and pansystolic murmur. His pulse rate and blood pressure were 64 beats/min and 170/65 mmHg, respectively. The other systems were essentially normal. A review by an experienced anesthetist (ME) placed the patient in the Association of American Anesthesiologist IV (ASA IV). An assessment of emergency impacted upper denture in elderly patient with cardiac valvular lesion and ASA 1V category was made. Cervical X-ray could not be done because the X-ray machine was faulty. The patient had the denture extracted under local anesthetic agent (10% lignocaine spray) and was successfully escorted out of the theater very excited. He was sent home 2 h post-extraction.