An Unusual Case of Tongue Entrapment in a Plastic Water Bottle

Abstract

Background: Foreign bodies inside the oral cavity are commonly encountered among children. One peculiar occurrence is when the tongue gets entrapped in foreign bodies such as bottles. This happens as children often insert their tongues into the bottle and apply oral suction to ingest the last few drops from the bottle. There is a paucity of data in Indian literature and no recommended guidelines for the management of such cases. Clinical Description: The patient, a 12-year-old boy had a history of inability to remove a plastic water bottle sipper from around the tongue while swallowing water quickly. He was initially asymptomatic and then he started developing progressive pain and swelling on the anterior part of the tongue. On examination, the plastic sipper was constricting the tongue circumferentially and the patient felt a sharp pain on maneuvering the bottle. Minimal discoloration of the anterior part of the tongue had set in 1 h after the presentation. Management: Lubrication with 2% lignocaine jelly and ice packs circumferentially followed by attempts of gentle traction and manipulation to remove the foreign body were unsuccessful. Consequently, the patient was shifted to the emergency operation theater where the patient was sedated with intravenous (IV) ketamine and midazolam after securing a nasopharyngeal airway with 100% preoxygenation. An orthopedic bone cutter was used, and a radial cut was given on the impacted end of the bottle, and the constricted part was removed as pressure on the tongue was released, followed by 100% oxygenation with bag and mask ventilation. Conclusion: Immediate intervention in cases of the entrapped tongue can prevent grave consequences such as airway compromise and tongue ischemia and necrosis. Mechanical removal can be done safely using heavy scissors or orthopedic bone under IV sedation after securing the airway in collaboration with the anesthesia team.

Keywords

• deep sedation
• foreign bodies
• mouth
• surgical instruments