A 12-year-old patient who was in active orthodontic treatment came to the clinic accompanied by her mother. They did not have an appointment scheduled, which is always cause for concern. The mother explained to me that her daughter had been life-flighted to a pediatric hospital 200 miles away and had just been released after a three-day stay. She had undergone a three-hour surgery to remove a wire from the back of her esophagus (Fig. 1).
The evening of the flight for life, the patient’s family had eaten grilled hamburgers, and the patient had difficulty swallowing. Her mother asked me if I thought there could have been a wire in the hamburger or the tomato. That seemed highly unlikely, so I ruled out that possibility. After examining the wire that had been removed during surgery, I became quite concerned because it resembled an orthodontic wire (Fig. 2). I was able to place a permanent bend in the wire, however, which would have been difficult to do with the patient’s .016" nickel titanium archwire.
I told the patient’s mother that if I had harmed her daughter in any way, I wanted to do my best to make things right. I was certain that the emergency had been costly, so I offered to help take care of her medical deductible and told her to keep track of their out-of-pocket expenses. I suggested that we give the patient some time to heal and feel better, and then take progress records in a few days. Fortunately, the patient never had trouble breathing; it only hurt to swallow.
Fig. 1 12-year-old female patient with wire lodged in esophagus.
The following day, I contacted my malpractice insurance provider]* and filled out an incident report. The representative told me that my risk-management protocol had been “spot on,” but cautioned me not to make any promises. Nevertheless, I assured the mother that we would work things out together. I also contacted her to make sure that her daughter was healing and that no other problems had presented.
Fig. 2 Wire removed during emergency surgery.
After many nights of lost sleep, I was still having trouble coming up with a scenario to explain the wire.1 For the nickel titanium wire to be bent, it would have had to be annealed to alter its metallurgy. The only purpose of annealing the wire would have been to bend it back distal to the molar bracket, thus preventing it from sliding around. This archwire did not have a bend in it, however, and the annealed part of the wire would have been excessively long: the recovered wire was about 22mm long, whereas one would normally anneal only 5mm or less. Furthermore, my assistant was completely sure that she had not annealed the archwire. The only scenario I could come up with was that too much of the archwire had been annealed, and the wire had migrated out the back of the molar tube. My thought was that metal fatigue caused the wire to break when the patient was repetitively chewing her hamburger, and she then swallowed the wire, which lodged in the back of her esophagus.
I had lunch with the patient’s dentist just before the patient was to return for progress records. As we were discussing the case, the idea arose that perhaps the patient’s mother had cleaned her grill with a wire brush prior to cooking the hamburgers. Eureka! Everything finally made sense.
I asked the mother if she usually cleaned her grill before cooking, and she said that while she typically does not, the grill had been dirty and greasy that evening, and she had in fact cleaned it with a wire brush. The progress records indicated that the wire had not migrated out the back of the molar tube, nor had it been annealed, confirming that this problem had not been caused by the orthodontic treatment.
The patient’s mother was wonderful throughout the entire process and was genuinely interested in figuring out what happened. For my part, I was greatly relieved that I had not harmed my patient. A few days later, I sent the family a bristleless brush for their barbecue grill.
FOOTNOTES
- *MedPro, Fort Wayne, IN; www.medpro.com.
REFERENCES
- 1. Bradford, C.B.; Shroff, B.; Strauss, R.A.; and Laskin, D.M.: A needle in a haystack: Report of a retained archwire fragment in the pterygomandibular space, Am. J. Orthod. 155:881-885, 2019.
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DR. ASTUTO
Dr. Astuto is in the private practice of orthodontics, 7901 S.W. 45th Ave., Amarillo, TX 79119; e-mail: steveastuto@gmail.com.
COMMENTS
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