title: Enigma of missing teeth in maxillofacial trauma.
abstract: OBJECTIVE
  The initial evaluation and treatment of trauma victims should follow a planned approach, as delineated by the Advanced Trauma Life Support protocol, with the main concern securing a patent airway. When trauma has been associated with maxillofacial injury, it can complicate airway management owing to aspirated avulsed teeth or dental prosthetic devices. In such cases, endotracheal intubation can be life-threatening, if the foreign bodies are pushed into the upper respiratory tract. The objective of the present report was to illustrate the diagnostic and management problems related to foreign bodies from the oral cavity lodged in the upper airway after blunt maxillofacial trauma or emergency endotracheal intubation. We also discussed how this could be prevented.
  
  
  METHODS
  A retrospective study was performed at the Department of Oral and Maxillofacial Surgery, Hadassah Medical Center (Jerusalem, Israel). The records of 1,411 patients admitted for treatment of facial trauma during the past 10 years were reviewed.
  
  
  RESULTS
  Of the 1,411 patients, 7 (0.5%) had aspirated foreign bodies that had lodged in the airway because of the trauma or subsequent intubation.
  
  
  CONCLUSIONS
  The patient's oral cavity and upper airway must be inspected thoroughly before attempting endotracheal intubation. Any foreign body should be removed from the mouth and throat. This process must be undertaken, despite the stressful and limiting conditions of emergency care.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Hebrew University, Hadassah University Medical Center, Jerusalem, Israel. nard@md.huji.ac.il
authors.forename: Nardy
authors.initials: N
authors.lastname: Casap
authors.forename: Michael
authors.initials: M
authors.lastname: Alterman
authors.forename: Sivan
authors.initials: S
authors.lastname: Lieberman
authors.forename: Rephael
authors.initials: R
authors.lastname: Zeltser
mesh_terms: D000328:Adult; D058109:Airway Management; D001980:Bronchi; D001999:Bronchoscopy; D003832:Denture, Partial, Removable / Q000009:adverse effects; D005547:Foreign Bodies / Q000209:etiology / Q000628:therapy; D006801:Humans; D007013:Hypopharynx; D007180:Incisor / Q000293:injuries; D007442:Intubation, Intratracheal / Q000009:adverse effects; D007828:Laryngoscopy; D007830:Larynx; D008297:Male; D008446:Maxillofacial Injuries / Q000150:complications*; D010614:Pharynx; D053120:Respiratory Aspiration / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies; D014084:Tooth Avulsion / Q000209:etiology*; D014949:Wounds, Nonpenetrating / Q000150:complications; D055815:Young Adult