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CASE REPORT

Removal of impacted denture by rigid Esophagoscope after failed flexible endoscopy: Report of a case
Sandeep Nijhawan, Sunil Samdani , Amit mathur , Neeraj Nagaich
Department of Gastroenterology, SMS Medical College, Jaipur

ABSTRACT
Endoscopic retrieval of impacted dentures is difficult. Traditional thoracotomy is associated with significant morbidity. We present a case of impacted denture in the mid -oesophagus successfully removed using rigid esophagoscopy under general anesthesia after two unsuccessful flexible endoscopy attempts. (J Dig Endosc 2012;3(2):45-46) Keywords: : Impacted esophageal denture Upper GI endoscopy Rigid esophagoscopy

Introduction
Because of their large size and pointed edges, dentures get frequently impacted and are associated with high morbidity and mortality [1]. Traditional thoracotomy is associated with significant morbidity[2]. Flexible endoscopic removal of impacted dentures is possible if patient presents early. Long history of ingestion and impaction makes endoscopic removal almost impossible; surgery is often required [3]. We present a case of a denture impacted in the oesophagus managed by rigid esophagoscopy.

Discussion
Impacted dentures can cause many complications [4]. Historically, the initial method of managing esophageal foreign bodies was extraction through the rigid esophagoscope[5]. In 1966, Bigler reported a new technique using a Foley catheter[6] and in the 1970s and 1980s the flexible fiberoptic instrument became an option. At present, flexible and rigid esphagoscopy are the two universally applicable methods for removal of esophageal foreign bodies. The success rate with the use of the rigid instrument ranges between 94 and 100% of instances[7] and the estimated incidence of perforation is 0.34%, with a 0.05% mortality rate[8]. The success rate of flexible esophagoscopy ranges between 76 and 98.5%[9] and the morbidity (perforation) rate is between 0% and 0.5%[9]. In our patient as the denture was impacted for more than a month, flexible endoscopic extraction was impossible due to partial migration into the wall. The snaring of the denture could not be done due to non availability of free edge
Reprints requests and correspondence: Dr. Sandeep Nijhawan 112 Panchsheel-Enclave, Gokul Bhai Bhatt Marg Near Clarks Hotel, Durgapura Jaipur-302018 (India) E-mail address- dr_nijhawan@yahoo.com Phone 0141 2722335

Case Report
A 32-year-old male presented with odynophagia after a month of accidental swallowed denture. Vitals were stable with no signs of perforation. Flexible upper GI endoscopy revealed impacted denture in the mid oesophagus at 24 cm with its flanges embedded in the oesophageal wall. Two sessions of flexible endoscopy using different accessories failed to retrieve dentures. The patient was referred to ENT department and was subjected to rigid esophagoscopy under general anesthesia. As both ends were embedded in the esophageal wall, the denture was disimpacted first and displaced down, then it was rotated and removed with help of alligator forceps. The procedure and follow up was uneventful .

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Journal of Digestive Endoscopy 2012;3(2):45-46

Removal of Impacted Denture

Nijhawan et al 2. 3. Chua YK, See JY, Ti TK. Oesophageal-impacted denture requiring open surgery. Singapore Med J 2006;47:820-1. Yang CY. The management of ingested foreign bodies in the upper digestive tract: a retrospective study of 49 cases. Singapore Med J 1991; 32: 312-5. Abdullah BJ, Teong LK, Mahadevan J, Jalaludin A. Dental prosthesis ingested and impacted in the esophagus and orolaryngopharynx. J Otolaryngol 1998;27:190-4. Jackson C, Jackson C. Bronchoesophagology. Saunders, Philadelphia 1959, 24662. Bigler FC. The use of a Foley catheter for removal of blunt foreign bodies from the esophagus. J Thorac Cardiovasc Surg 1966;51:75960. Chaikhouni A, Kratz JM, Crawford FA. Foreign bodies of the esophagus. Am Surg 1985;51:1739. Giordano A, Adams G, Bois L Jr, Meyerhoff W. Current management of esophageal foreign bodies. Arch Otolaryngol 1981;107:24951. Webb WA. Management of foreign bodies of the upper gastrointestinal tract: update. Gastrointest Endosc 1995; 41:3951. Blair SR, Graeber GM, Cruzzavala JL, Gustafson RA, Hill RC, Warden HE, Murray GF. Current management of esophageal impactions. Chest 1993;104:1205-9.

of the denture. The endoscopic rat tooth forceps failed because of the rounded and thick edges of the ridge of the denture. The wide lumen of the rigid instrument is of great help in manipulating the foreign body and extracting it[10]. The alligator forceps of the rigid esophagoscope has a larger span which can successfully catch the ridge of the impacted denture firmly to facilitate its disengagement . Results for removal of dentures by flexible endoscopy can be improved by early intervention, use of general anesthesia and development of dedicated accessories for removal of sharp and larger foreign bodies. This case is an example that rigid esophagoscopy can be useful when the foreign body though visible but is not amenable to extraction by flexible endoscopy.

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Conclusion
Ingested impacted denture in the esophagus with a long history could not be retrieved with flexible endoscopy and available accessories. Rigid esophagoscopy is useful in such situations if it is within the reach of the rigid scope by using the alligator forceps.

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References
1. Stiles BM, Wilson WH, Bridges MA, Choudhury A, RiveraArias J, Nguyen DB, Edlich RF. Denture esophageal impaction refractory to endoscopic removal in a psychiatric patient. J Emergency Med 2000;18:323-6.

Source of support: Nil; Conflict of interest: none declared

Journal of Digestive Endoscopy 2012;3(2):45-46

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