DENTURE IMPACTION IN THE OESOPHAGUS: CORRELATION OF SITE AND DURATION OF IMPACTION WITH SEQUELAE

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A.A. Adeyemo^{1, 2}, and S.A. Ogunkeyede^2,3

1. Institute of Child Health, College of Medicine, University of Ibadan, Ibadan
2. Department of Otorhinolaryngology, University College Hospital, Ibadan
3. Department of Otorhinolaryngology, College of Medicine, University of Ibadan, Ibadan

Abstract

Background: Denture restores aesthesis and function of missing teeth. Accidentally swallowed denture is an otorhinolaryngology emergency. The types of denture base and oesophageal anatomy infuluence the site of impaction.

Objective: To review site of denture impaction and factors associated with site of impaction. To correlate site and duration of denture impaction before removal with associated sequelae.

Method: A retrospective study of 27 patients managed in Otorhinolaryngology Department of University College Hospital Ibadan, Nigeria for oesophageal partial denture impaction, between August 2006 and September 2016. The demographic and clinical data of the patients were extracted from the hospital records, and statistical tables were used to illustrate the data.

Results: A total of 27 patients; 14(51.9%) males and 13(48.1%) females, (M: F,1.1:1) were studied. The age ranged from 24 to 77 years (mean age 49.0 ± 14.2years). Dentures were worn for 3 to 30 years (mean 3.8 ± 2.3years) without follow-up visit to dentist and 85.2% were upper dentures. All patients had history of accidental ingestion of denture, and the mean site of impaction was 18.2 ± 3.2cm from upper incisor, typically at upper cervical oesophagus in elderly patients and in lower oesophagus in females. There was no association between site of denture impaction, duration of denture impaction and operative findings.

Conclusion: Advanced age and female gender are associated with site of dentureimpaction. Late hospital presentation significantly promotes sequelae associated with management of impacted dentures. It is recommended that fundamental changes in denture designs, education on regular follow-ups and avoidance of ill-fitting dentures would reduce the prevalence of denture impaction.

Keywords: Denture impaction, Health education, Oesophagus, Oesophagoscopy and Nigeria

Introduction

Missing teeth can compromise pronunciation, chewing with associated poor quality of life.¹ The desire to restore function and aesthetic has resulted in wearing of dentures.² Etruscans was the first to make partial dentures.³ Acrylic dentures are removable teeth replacement options which are made from a radiolucent polymethylmethacrylate material.⁴

Denture impaction in the oesophagus is a common otolaryngology emergency with management challenges. Patients usually present with dysphagia, throat pain, odynophagia and pooling of saliva in pyriform sinus.⁵ Factors responsible for dislodgment of dentures from the alveolar ridge and subsequent impaction in the esophagus are: poor fit of the denture at insertion, prolonged usage, and failure of dental clinic follow-up evaluations especially when the denture becomes loose.⁶

In addition the insulating nature of acrylic dentures reduces sensitivity of the oral cavity.⁷ The large surface area of the dentures and their pointed edges encourages impaction in the aerodigestive tract. Impacted dentures are typically found at anatomically narrow areas of the oesophagus; the cricopharyngeal sphincter⁸, the level of the aortic arch, left bronchus, left atrium and at the lower esophageal sphincter⁹.

Oesophageal denture impaction ranges between 1.3% – 38.6% in clinical practice,^10,11 and the management outcome depends on: site of impaction, shape and size of the denture, duration of impaction, premorbid medical conditions of the patient, the surgeon’s expertise and availability of appropriate instruments, especially in resource limited countries.

Historically impacted oesophageal foreign bodies are removed through rigid esophagoscope¹², currently both flexible and rigid esophagoscopy are used for removal of oesophageal foreign bodies, with varying degree of success and mortality rates.^13,14 Other methods includes; cervical oesophagotomy, the use of Foley’s catheter under fluoroscopic guidance¹⁵ and the use of flexible esophagoscopy with polypectomy snare.¹⁶ Delay in removal of the impacted denture in oesophagus increases the risk of complications such as oesophageal obstruction, pressure necrosis, oesophageal perforation, pulmonary aspiration, sepsis and mediastinitis.¹⁷

Evaluating the local pattern of denture impaction and related sequelae will provide relevant data to boost patient-doctor communication, health promotion and public health education on the risks associated with denture and failure of routine denture evaluation at clinics.

This study evaluated site of denture impaction and likely factors responsible for impaction at those sites, it also correlated the sites of denture impaction and associated sequelae.