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Official Journal of the Italian Society of Maxillofacial Surgery
Frequency: 3 issues
Online ISSN 1827-1901
Schaaf H. 1, Streckbein P. 1, Grimm E. 2, Howaldt H.-P. 1
1 Department of Oral and Maxillofacial Surgery University Hospital Giessen and Marburg Campus Giessen, Germany
2 Department of Anesthesiology, Intensive Care Medicine Pain Therapy University Hospital Giessen and Marburg Campus Giessen, Germany
The aim of this paper was to report an unusual case of the coincidental finding of a pulmonary tumor, 15 years after treatment of a squamous cell carcinoma of the lower jaw. A 76-year old woman presented with inadequate prosthetic rehabilitation and a complicated soft tissue condition in an atrophic jaw. In patient history, a squamous cell carcinoma, which was located in the left mucosa of the lower jaw, had been treated by surgery and radiation in 1991. In 2007 four dental implants were placed in the mandible. During the reopening procedure the screwdriver accidentally dropped into the oral cavity and disappeared. Radiographs of the thorax, which were immediately generated, showed the screwdriver in the left main bronchus. In addition, a round retrosternal focus could be detected. First the screwdriver was retrieved by bronchoscopy. Then, a computed tomography scan of the thorax was performed for clarification of the retrosternal focus. In suspicion of a bronchial tumor, the lesion was removed by thoracotomy and resection of the upper right pulmonary lobe was carried out. Histopathological examination revealed in a carcinoma lesion, which could be interpreted either as metastasis of the former oral squamous cell carcinoma or as a bronchial carcinoma. The immediate control of an inhaled or ingested foreign body by radiographic imaging is absolutely essential. The case showed that the screwdriver was aspirated, even though the patient did not cough in reflex. Accidental findings on a radiograph must be tracked and, if necessary, be subsequently treated.