Right Under Your Nose! A Search for a Dislodged Tooth Discovered in the Nasopharynx by Lateral Neck Radiograph

During nasotracheal intubation for mandibular fixation surgery in an 85-year-old man, a loose tooth was inadvertently dislodged and remained undetected despite repeated laryngoscopic and bronchoscopic exploration. Antero-posterior chest, abdominal, and neck x-rays also failed to locate the tooth. A lateral neck radiograph was then obtained, which revealed the tooth in the nasopharynx. A nasopharyngeal airway was inserted, enabling the tooth to be successfully displaced caudally and extracted. This case highlights the value of lateral neck x-rays in identifying foreign bodies, especially in supine patients where objects may fall posteriorly and cephalad into the nasopharynx.