We read with interest the article recently published by Gómez López et al.,1 reporting a case of bronchoaspiration of a metal odontological foreign body. The authors emphasize the unusual nature of the aspirated material, since only 2 cases have been published, 1 of which was reported by the same authors.

In our hospital, we have had the opportunity to extract foreign bodies similar to that reported by the authors from 3 patients. In the first of these cases, on March 14, 2007, a foreign body was located in a 71-year-old man and subsequently extracted in the operating room under general anesthesia with rigid bronchoscopy and basket. On July 9, 2009, odontological material was extracted from a 63-year-old woman in the bronchoscopy room, with flexible 2.2mm forceps under topical anesthesia only. On June 10, 2014, we attempted to extract material from the third patient, a 75-year-old woman, in the bronchoscopy room with flexible bronchoscopy and sedation with midazolam. The attempt failed, so the following day the silicon prosthesis was removed with rigid bronchoscopy and rigid forceps under general anesthesia in the operating room.

In all cases, the patients were undergoing dental surgery with osseointegrated implants at the time of aspiration of the foreign body. The objects were lodged in the right bronchial tree (basal pyramid and intermediate bronchi), the effect of gravity causing the thickest section to settle in the distal position, with the point facing upwards, facilitating removal by the endoscopist, as described by Leuzzi et al.2 The bronchoaspirated material to which we refer3 is the surgical steel tip of a manual torque wrench, 20mm in length (several different sizes are marketed), with a 1.31mm hexagonal tip. This device is attached to the torque wrench and used to screw in the titanium abutment screw, a step phase in this type of surgery. For safety purposes, these tips have a rotating crown which allows the screw to be turned, and is furnished with a small hole, as can be seen in the image, into which dental floss is introduced to prevent it falling and being aspirated (Fig. 1).

Fig. 1.

Tip of manual torque key.

(0.13MB).

Our experience prompts us to make some comments. The methods of extraction in each of our 3 cases were very different, and the procedure depended basically on the degree of collaboration of the patient, and either flexible or rigid bronchoscopy was used to the same effect. We would advise an initial attempt with the former, as it is much more accessible in our hospital setting. However, any difficulty encountered during this procedure can be easily overcome with the use of rigid bronchoscopy. We were asked to provide 2 of the extracted pieces, which were presented as evidence in subsequent legal claims. Thus, we highlight the need for prevention of accidents of this kind, in view of their frequent occurrence, potential severity, and medical and legal implications.