Occasionally a foreign body is aspirated or inhaled during orthodontic treatment. The patient needs to be immediately evaluated to determine if something serious has happened.
(1) airway compromise
(2) sharp foreign body aspirated or swallowed with bleeding or perforation
(1) something easily retrieved from the pharynx
(2) something that can be coughed out
(3) something small and smooth that has been swallowed
Intermediate situation: everything else
(1) Avoid panic.
(2) Maintaining the airway is critical. If the object cannot be retrieved then a Heimlich maneuver should be considered. A cricothyroidotomy may be required.
(3) Try to determine what has been lost. Characterize it by size, shape and material.
(4) The patient should be taken to an Emergency Department for assessment.
(5) Imaging studies can be helpful to confirm or determine what has been lost and where it is.
(6) Many objects can be retrieved by endoscopy (bronchoscopy, upper GI endoscopy).
(7) If something has been swallowed then it may be elected to let it pass through the gastrointestinal tract. This approach requires monitoring to confirm passage (by examining stool, by disappearance on X-ray).
(8) Surgery may be needed if all else fails or to manage a perforation.
(9) Make sure that everything has been accounted for.
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