Apparent missing tooth due to traumatic dental intrusion during airway management

The probability of a mobile tooth being dislodged and misplaced during laryngoscopy, especially in the setting of a difficult airway, ranges between 0.06% and 25% [1, 2]. This may occur despite appropriate measures such as dental padding or buddy wrapping with the neighbouring tooth. The most commonly affected tooth is the upper left lateral incisor [1]. We describe one such case in a 10‐year‐old boy with a traumatic Ellis class III dentoalveolar and mandibular fracture, where the right maxillary incisor was noted to be missing after naso‐tracheal intubation using videolaryngoscopy, following induction of general anaesthesia. A review of the pre‐operative orthopantomogram confirmed the presence of the tooth. Intra‐operative upper airway endoscopy, and radiographs of the chest (anteroposterior and lateral), soft tissue neck and abdomen failed to identify the location of the tooth. Airway pressures remained within the expected range, making an endobronchial foreign body less likely. The decision was made to proceed with the open reduction and internal fixation of the fracture. Upon cleaning and draping the surgical field, the missing tooth was located within its alveolar socket (Fig. 1). There is a classic adage in general surgery : ‘pus somewhere, pus nowhere else, pus under the diaphragm’; our case inspires an adaptation: ‘tooth somewhere, tooth nowhere else, tooth in its socket’. Awareness of this finding may potentially save time, radiographic exposure, unnecessary procedures and distress to the patient [3].

Figure 1.

Images following tracheal intubation, under general anaesthesia: (a) Anteroposterior chest radiograph without any abnormal radio‐opaque foreign bodies; (b) Blue arrow points to the right upper incisor that has receded into its socket (magnified in picture inset).