The 72-year-old man could not figure out what was wrong with his throat. Following a minor operation on his abdomen, he had been in pain, coughing up blood and unable to swallow solid food for almost a week.
But when emergency room doctors examined the back of the man's throat, they found nothing unusual. After ordering a chest X-ray and blood tests, they told the man he had a lower respiratory tract infection and he was sent home with medication. The pain, doctors said, was likely a lingering side effect from having a tube inserted in his throat during the surgery.
It wasn't until the man's condition worsened, prompting a second trip to the emergency room, that doctors finally discovered the real source of his symptoms: His dentures, which he thought were lost during an operation eight days earlier, had actually been lodged in his throat the entire time, according to an article published Monday in the peer-reviewed journal BMJ Case Reports. The article did not identify the man or the hospital.
The man's case brings attention to the risks of leaving dentures in the mouths of patients undergoing surgeries that require general anesthesia, wrote the article's author, Harriet A. Cunniffe, an otolaryngologist at James Paget University Hospitals NHS Foundation Trust in the U.K.
"There are no set national guidelines on how dentures should be managed during anaesthesia," Cunniffe wrote, adding that many hospitals allow false teeth to be left in place until right before a patient is intubated.
It is unclear why the man's dentures were not taken out during the surgery to remove a benign lump from the wall of his abdomen, but by the time he awoke, the teeth were nowhere to be found, the report said. Believing the dentures had been misplaced somewhere at the hospital, the retired electrician went home and likely didn't give it another thought, according to the report.
Six days later, he was in the emergency room.
But the medicine from the initial visit appeared to have little impact, the article said. In two days, he was back at the hospital again - this time with even more symptoms. Now, as he told doctors that he couldn't swallow the medication and was still coughing blood, he spoke in a "hoarse breathy voice," according to the report. He was also having a hard time breathing, especially when he laid down, which forced him to start sleeping sitting upright on his couch.
Doctors were concerned that he had developed pneumonia from inhaling something and admitted him to the hospital. Further examinations of his neck found nothing amiss, until a thin flexible tube with a camera on the end was inserted through his nose and into his throat.
A "metallic semicircular object" was covering his vocal cords, "completely obstructing their view," the report said. It was wedged against the man's epiglottis, a flap in the throat that keeps food from entering the windpipe and lungs, and had caused irritation and swelling.
When the man was told about the unidentified object, he remembered his missing dentures - a metallic plate with three front teeth affixed to it. A trip to the X-ray provided confirmation and the man was whisked off to the operating room, where the dentures were plucked out with a pair of forceps.
The man's recovery, however, wasn't quite as simple.
Over the course of several weeks after the denture removal, the man returned to the hospital multiple times still coughing up blood, the article said. During one visit, doctors estimated he had lost 1.5 liters of blood, or about three pints. The average adult has between nine and 12 pints of blood circulating inside their body, according to Live Science.
The source of the bleeding was eventually discovered to be "a spurting arterial vessel" in the man's throat that had been obscured by tissue that formed over it during the healing process, according to the report. The man was rushed into another emergency surgery to repair the artery and appeared to recover well from the procedure, the report said.
Cunniffe, the report's author, wrote that the man's case "highlights a number of key learning points for anaesthetists, theatre staff, emergency physicians and ear, nose and throat (ENT) surgeons alike," but noted that it is not the first of its kind.
A 15-year review of more than 80 cases worldwide in which dentures ended up in airways found six instances that occurred when people were under general anesthesia, according to research published in 2016 in the Journal of Oral & Maxillofacial Research. In 1976, a 49-year-old woman died after a fragment of her dentures was inhaled when a breathing tube was placed in her throat. More recently, a case report published in May detailed an incident of a 50-year-old man swallowing his dentures during sedation. He later passed the false teeth through his digestive system, the article said.
The British man's experience also emphasizes another important lesson for doctors: "Always listen to your patient," Cunniffe wrote.
While the chest X-ray and bloodwork indicated a respiratory infection, the tests "acted as a distraction," she wrote. Looking back at the symptoms the man presented during his emergency room trips, Cunniffe wrote that it was clear he had come in because of a sore throat and difficulty swallowing.
"Listen to the story the patient is telling you and do not be distracted by positive findings on investigations," she wrote.