Flexible Bronchoscopic Retrieval of an Aspirated Tooth in Severe Radiation-Induced Trismus: A Case Report

Foreign body aspiration is uncommon in adults but can result in significant morbidity, particularly among head and neck cancer survivors, who frequently develop dysphagia, impaired airway protection, and radiation-induced trismus. We report the case of an 82-year-old man with a remote history of head and neck squamous cell carcinoma treated with radical neck dissection and radiotherapy who aspirated an extracted molar during a dental procedure complicated by severe trismus. Computed tomography demonstrated the tooth within the right bronchus intermedius. Rigid bronchoscopy was considered unsafe because of restricted mouth opening, and standard bite-block placement was not feasible. Flexible bronchoscopy was therefore performed through a nasopharyngeal approach under moderate sedation. The tooth was captured with a retrieval basket and withdrawn into the oropharynx. Because the irregular dental fragment posed a risk of mucosal injury during extraction through the restricted oral aperture, the patient was repositioned in a slight Trendelenburg and left lateral decubitus position, allowing for successful manual removal with forceps. This case highlights the technical challenges of foreign body retrieval in patients with radiation-induced trismus. In this patient, a staged transnasal flexible bronchoscopic approach followed by direct manual extraction allowed successful foreign body retrieval when conventional rigid or oral bronchoscopic techniques were not feasible. This approach may represent a feasible alternative in carefully selected patients with similar anatomic constraints.