by Dr. Saif Sayyed
by Dr. Saif Sayyed
Dentures are one of the most notorious foreign bodies in the esophagus. Sharp, pointed,
serrated edges, metal wire or clasps can lead to damage of the strongest mucosal and submucosal layers of esophagus. This produces direct injury, linear ulceration, compression edema with mucositis, penetration, perforation and fistula.
Denture made of acrylic material with or without hook wire or clasp and sharp edges (collects) used for more than five year, were not retentive or rugged, and could not readily withstand the forces generated during daily use. Moreover, an upper partial denture without the contact
of the lips during drinking could be a predisposing factor or denture impaction.
The commonest site of the impaction in this study was upper one third of the esophagus to be followed by cricopharyngeal junction and then other sites of anatomical narrowing.
Non retentive unstable swallowed partial dentures when impacted in the oesophagus can be a diagnostic and therapeutic challenge. The incidence of swallowing partial denture is reported in
range of 3.6% to 27.7% with adult preponderance. Other ingested foreign bodies of dental origin are transpalatal arch, a fragment of upper removable appliance, a piece of arch wire and a lower spring retainer.
The strategy for management of impacted denture in the oesophagus was removal. Esophagoscopic removal of impacted denture was by identification followed by direct vertical traction in 3 cases, and identification, disimpaction by horizontal rotation followed by vertical traction with forceps in one case. Left cervical oesophagotomy, disimpaction of
the denture and removal was performed in 46 cases at AIIMS. Disimpaction with horizontal rotation and removal of impacted denture was performed after carefully observing the reactionary edema, inflammation, ulceration, linear tear, perforation and fistula. Repaired oesophagus was reinforced with pleural flap andintercostals muscle bundle. The intra operative abscess, perforation fistulae and haemorrhage were tackled while removal of denture by debridement closure and good haemostasis esophagus was then meticulously closed.
The major lesson learnt from this published literature was that a partial dentures being small were easy target for accidental swallowing and dangerous due to their configuration, dimension and over all rotation in the esophagus. The hazard of small side plate and hook or
clasp had long been recognized. The principles of direct and indirect retention and cross arch bracing were important. Medical personnel should be aware of these multiple hazards.
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