Clinical Reports. Esophagotomy for Removal of an Artificial Denture. [Volume: 29, Issue: 1, January, 1887, pp. 20-21]

ESOPHAGOTOMY FOR REMOVAL OF AN ARTIFICIAL DENTURE. 21

attached three incisors, one lateral incisor having been lost from the
plate. The denture was arrested in its passage downwards, producing intense pain and partially obstructing respiration, while
deglutition, even of liquids, was rendered impossible. A physician
was summoned, who detected the plate in the upper portion of the
esophagus; but all efforts to remove it or force it into the stomach
were futile. Sufficient opium to relieve the pain having been administered, on the following day (Monday) he was brought by his
physician to the Infirmary of the University of Maryland, and
placed under the care of Dr. L. McLane Tiffany, professor of surgery. On the same afternoon, the patient having been etherized,
careful attempts to remove the plate were made, but it was so firmly
impacted in the upper portion of the esophagus that all efforts for
its removal failed. On Tuesday, in the presence of the medical and
dental classes, the patient was again etherized and efforts made to
remove the plate through the mouth, but without success.
The patient lying on his back, with his face turned to the right,
so as to render the tissues of the left side of the neck tense, Prof.
Tiffany made an incision about four inches in length through the
integument over the depression between the trachea and the sternomastoid muscle. The anterior jugular vein was cut and ligated,
and the incision extended from opposite the upper border of the
thyroid cartilage nearly as low as the sterno-clavicular articulation.
The platysma myoides muscle and the cervical fascia were then
divided. The edges of the wound being held apart with retractors,
the omohyoid muscle was drawn outwards, and the sternohyoid
and sternothyroid muscles inwards. The carotid sheath, with the
contained vessels, was exposed and carefully drawn outwards, while
the thyroid gland was separated as far as necessary, and drawn
inwards. The larynx and trachea were drawn somewhat forward,
and the finger passed behind, where the foreign body could be distinctly felt through the esophagean wall.
Care being taken to avoid the recurrent laryngeal nerve, an incision large enough to admit the finger was made into the esophagus, through which the exact position of the set of teeth was ascertained. Forceps were then introduced, and the plate removed
intact. The wound, after being thoroughly cleansed, was dressed
with antiseptic gauze and absorbent cotton, no sutures being employed. On the following Thursday the patient was walking about
his room, having a normal temperature and pulse. He was fed by
means of a stomach-tube for six days, after which he was able to
swallow liquid food with little or no pain, and the external wound
had nearly closed.