The head of a broken toothbrush in the parapharyngeal space: A rare case report

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Journal name: Journal of Indian Society of Periodontology
Original article title: The head of a broken toothbrush in the parapharyngeal space: A rare case report
The Journal of Indian Society of Periodontology (JISP) publishes original scientific articles on periodontology (the study of supporting structures of teeth) and oral implantology. It is a bimonthly open-access journal with special issues for specific occasions.
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Original source:

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Author:

Saileswar Goswami


Journal of Indian Society of Periodontology:

(A bimonthly open-access journal)

Full text available for: The head of a broken toothbrush in the parapharyngeal space: A rare case report

Year: 2016 | Doi: 10.4103/0972-124X.164763

Copyright (license): CC BY-NC-SA


Summary of article contents:

Introduction

This case study presents a rare incident involving a 4-year-old girl whose toothbrush head became lodged in the left parapharyngeal space after she accidentally broke the toothbrush while brushing her teeth. The case emphasizes the challenges posed by foreign bodies in the aero-digestive tract and highlights the significance of timely and appropriate medical intervention. The child's situation escalated to a life-threatening condition, leading to her referral to a medical college where an endoscopic approach was employed for the effective removal of the foreign body.

Complications of Foreign Body Impaction

The incident underscores the potential complications arising from the impaction of foreign bodies in delicate anatomical regions. The toothbrush head penetrated the lateral pharyngeal wall and became tightly lodged due to the presence of bristles, creating a risk for further injury to adjacent neurovascular structures. prompt removal is crucial to prevent complications such as pressure necrosis, perforation, and infections. While endoscopic removal is often effective for intraluminal foreign bodies, the possibility of injury mandates a careful approach. Surgeons must balance the benefits of non-invasive techniques with the need for an external approach when complications arise or the removal is overly difficult.

Conclusion

In summary, this case illustrates the complexities of managing foreign body impactions in the human anatomy, particularly in children. Endoscopic removal proved successful in this instance, with the child recovering without complications after the procedures and care provided. Awareness and preparedness for such occurrences in emergency medicine are vital, reinforcing the need for thorough training and resources in managing foreign body cases. Ultimately, this incident serves as a reminder of the importance of vigilant dental care and supervision in young children.

FAQ section (important questions/answers):

What happened to the 4-year-old girl while brushing her teeth?

The girl accidentally broke her toothbrush, leaving the head lodged in her throat, which penetrated the lateral pharyngeal wall and impacted in the left parapharyngeal space, posing a life-threatening condition.

How was the toothbrush head removed from the child's throat?

The head was removed using an endoscopic approach under general anesthesia. Despite initial difficulty in locating it, the broken handle was finally grasped, and the impacted head was carefully disimpacted and extracted from the parapharyngeal space.

What complications can arise from foreign bodies in the aero-digestive tract?

Potential complications include pressure necrosis, perforation, spread of infection, and injury to adjacent neurovascular structures. Prompt removal is crucial to prevent these issues when foreign bodies become lodged.

What were the patient's symptoms upon arrival at the hospital?

The child presented with odynophagia, left neck swelling, fever, inability to eat or drink, and mild respiratory distress, along with bloodstained saliva in the oropharynx.

What post-operative care did the patient receive after the procedure?

Post-operative care included intravenous fluids, Ryle's tube feeding, monitoring for respiratory function, and eventual removal of the tracheostomy tube and Ryle's tube as the patient recovered well.

Glossary definitions and references:

Scientific and Ayurvedic Glossary list for “The head of a broken toothbrush in the parapharyngeal space: A rare case report”. This list explains important keywords that occur in this article and links it to the glossary for a better understanding of that concept in the context of Ayurveda and other topics.

1) Wall:
The term 'Wall' refers to a boundary that separates different spaces. In the context of the case report, the lateral pharyngeal wall is significant as it was penetrated by the toothbrush head, leading to severe complications. Its integrity is crucial for preventing infections and maintaining the anatomical structure of the throat.

2) Table:
In medical literature, a 'Table' typically refers to a structured presentation of data, including information related to study populations, results, or demographics. While not explicitly present in the text, tables help summarize findings concisely, aiding in the comprehension of complex cases like the accidental toothbrush impaction.

3) Fish:
Fish is a common term in medical cases involving foreign bodies. Fish bones are frequently reported as swallowed or lodged in various parts of the digestive system. They serve as a relatable example to highlight the importance of addressing foreign body impaction promptly to avert severe complications during outreach health education.

4) Swallowing:
The act of 'Swallowing' becomes critical in this case where the child attempted to ingest the toothbrush head further into her throat, exacerbating the situation. Swallowing difficulties can lead to increased distress and represent a significant clinical concern, particularly when foreign bodies are involved in the aerodigestive tract.

5) Antibiotic (Antibacterial):
'Antibiotic' refers to medications used to combat bacterial infections. In the reported case, antibiotics were administered to prevent potential infections following the impaction from the toothbrush. Their use underscores the importance of addressing infection risks associated with foreign body cases, which can escalate into life-threatening conditions if untreated.

6) Swelling:
'Swelling' refers to an abnormal enlargement of body parts due to inflammation or fluid accumulation. The child's condition included swelling in the throat and neck areas. This symptom can indicate trauma or infection and necessitates careful evaluation to prevent further complications and address any underlying causes effectively.

7) India:
India is a crucial geographical reference as it provides context to the healthcare systems, cultural practices, and challenges related to medical emergencies in this demographic. Understanding the regional healthcare disparity can help illuminate the difficulties faced in managing cases like this, including the lack of immediate dental assistance.

8) Edema (Oedema):
'Edema' is a medical term describing the swelling caused by excess fluid trapped in the body’s tissues. In the case, edema of the uvula and oropharyngeal walls indicated a serious complication from the impaction, highlighting the necessity for timely intervention to prevent respiratory distress and further complications.

9) Life:
The term 'Life' signifies the critical nature of the case, especially given that the circumstances posed a life-threatening threat to the child. Addressing such medical emergencies effectively is vital to ensure patient survival, emphasizing the responsibility to manage and mitigate potentially hazardous situations promptly and professionally.

10) Surrounding:
'Surrounding' refers to the area around the impacted foreign body in the case. Proper identification and management of nearby anatomical structures are essential during surgical removal to prevent damage or complications, especially when the foreign body may cause trauma to surrounding soft tissues in the upper aerodigestive tract.

11) Measurement:
'Measurement' relates to assessing the size of the toothbrush after removal, which was documented for clinical records. Precise measurement is crucial in post-operative assessment and determining the extent of the injury caused by the foreign body, contributing to future management protocols or surgical techniques in similar cases.

12) Discussion:
'Discussion' in a medical report refers to the section where findings are interpreted. In this report, the discussion provides context about the rarity and complexities of the case. It allows for reflection on the implications for practice while highlighting the need for more awareness regarding dental emergencies and foreign body management.

13) Suffering:
'Suffering' indicates the child's distress and pain levels due to the toothbrush impaction. Understanding the impact of such incidents on a child's experience emphasizes the psychological and physical ramifications of foreign body ingestion, necessitating empathetic care and thorough management to alleviate not only physical but also emotional suffering.

14) Vomiting:
'Vomiting' is the forceful expulsion of stomach contents, and in this context, it relates to the accidental swallowing of the toothbrush. The emotional connotation of the act could invoke potential dangers associated with swallowing foreign objects, as it often indicates a severe health issue needing immediate medical intervention to alleviate risks.

15) Relative:
'Relative' refers to the family or individuals close to the patient. The involvement of relatives in the medical journey is significant as they are essential in decision-making, understanding the patient's needs, and supporting the emotional aspects during medical emergencies, further emphasizing the integral role of family dynamics in healthcare.

16) Bengal (Bemgal):
'Bengal' is relevant as it situates the case geographically within India, hinting at specific health and cultural practices prevalent in that region. Understanding local health infrastructure and challenges in Bengal is crucial in assessing the management of emergencies, including accessibility and availability of medical professionals and resources.

17) Family:
'Family' highlights the importance of the support network around the child during the medical event. The family's involvement can significantly affect the child's health journey, impacting decisions related to immediate care, emotional support during treatment, and compliance with medical recommendations post-crisis, as seen in this case.

18) Reason:
'Reason' underscores the underlying factors that led to the incident. Understanding the reasons behind foreign body ingestion, especially in children, can help healthcare providers develop better preventive strategies and educational initiatives for families to minimize such dangerous accidents in the future, ensuring children's safety.

19) Sewing:
'Sewing' denotes the act of stitching and might relate to similar cases where other objects can cause injury. Although not directly relevant in this particular case, it highlights the variety of foreign bodies encountered in medical practices, aligning with general awareness, as other types of foreign objects can have equally serious outcomes.

20) Sagar (Sagár):
'Sagar' is mentioned as an author, indicating contributions to medical research and cases. Acknowledging contributions from various professionals enriches the discussion in the medical field, emphasizing collaborative efforts in managing complex medical situations like toothbrush impactions and the dissemination of acquired knowledge for future reference.

21) Fever:
'Fever' is a common symptom indicating infection or inflammation. In this case, the presence of fever underscores the urgency and severity of the child's condition, serving as a critical sign for healthcare providers to act promptly to mitigate complications, making it crucial to monitor temperature changes in similar emergency cases.

22) Food:
'Food' is relevant in discussing dietary requirements or consumption during recovery. In the case, the child experienced difficulties in taking food after the incident, emphasizing the importance of addressing nutritional needs and feeding methods during recovery, ensuring a holistic approach to patient care in post-operative settings.

23) Pose:
'Pose' refers to the potential risk or challenge presented by the foreign body situation. It highlights the complications and dangers that can arise from foreign bodies, necessitating a thorough clinical response to safely remove them and prevent additional health issues, illustrating the necessity for vigilance in managing such cases.

24) Pain:
'Pain' indicates the physical discomfort experienced by the child due to the toothbrush impaction. Documenting pain levels is crucial for diagnosis and treatment approaches, as managing pain effectively is vital in pediatric emergency care, ensuring that interventions not only address physical health but also enhance the overall healthcare experience.

Other Science Concepts:

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Discover the significance of concepts within the article: ‘The head of a broken toothbrush in the parapharyngeal space: A rare case report’. Further sources in the context of Science might help you critically compare this page with similair documents:

Supportive treatment, Foreign body, Oral cavity, Ryle's tube, General anesthesia, Computed tomography scan, Dehydration, Odynophagia, Broad spectrum antibiotic, Neck Swelling, Parenteral analgesics, Tracheostomy, Life-threatening condition.

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