By Jonny Lupsha, Wondrium Staff Writer
An Illinois man inhaled a drill bit at the dentist’s office in March. The one-inch bit landed in his lung and was removed at a nearby hospital shortly thereafter. Our airways are part of the respiratory system.
A 60-year-old Illinois resident’s trip to his Wisconsin-based dentist took a dramatic turn for the worse when he accidentally inhaled a one-inch dental drill bit. The potentially life-changing mistake was confirmed via CT scan and he was taken to the hospital. Doctors told him normal scopes couldn’t reach the bit, which sat low in his lung, and if they were unable to get it out they’d have to surgically remove a portion of his lung.
Fortunately a new medical device, ordinarily used to detect cancer early, reached the bit and doctors retrieved it. It had initially been thought that he may have swallowed it.
Why do things “go down the wrong pipe”? In his video series Understanding the Human Body: An Introduction to Anatomy and Physiology, Dr. Anthony A. Goodman, Adjunct Professor of Medicine at Montana State University, explains the anatomy of the respiratory system.
I Hate When That Happens
“In our evolutionary development, we had our digestive tract and our respiratory tract joined together,” Dr. Goodman said. “We can breathe through our nose, but we can also breathe through our mouth, and our airway comes together very closely with our digestive tract.”
This is, generally, a very good system. If our nose were completely obstructed—say, with congestion—we could still provide our body the oxygen it needs by inhaling through the mouth. The opposite is also true: If our mouth is full of food, we can still breathe safely in and out of our nose.
“The nasal cavity is much bigger than you think, when you just look at the little openings of the nose,” Dr. Goodman said. “[The nasal cavity and the mouth] join together in the back and meet at the airway. But if you get a closer look at this, you’ll see that not only are the trachea and airway here, but right behind it, we have the esophagus, which is where food goes down.”
Anyone who’s ever talked with a mouth full of food—or accidentally inhaled while taking a bite of a powdered sugar donut—knows this all too well.
The Ideal Pathway
Many foreign objects, if swallowed, will usually come back up as vomit or pass through our esophagus and the rest of the digestive tract with other food, ending up as waste. This may have happened to the drill bit in Wisconsin, had it gone down the esophagus. So how are the airway and esophagus separated?
“In the very back of the throat, not easily seen, is a piece of cartilage—cartilage is kind of the precursor to bone,” Dr. Goodman said. “It hasn’t been calcified. It’s flexible, but it’s very rigid, and not as rigid as bone, but not as flaccid as soft tissue. It’s called the epiglottis.”
The airway is in front of the esophagus, and the epiglottis essentially flaps back and forth depending on which duty the mouth is performing, providing access to either the airway or the esophagus. The epiglottis spends the vast majority of its time providing access to the trachea and the rest of the airway, flapping over to open the esophagus when we swallow, then right back.
“Again, you can defeat this by trying to talk, which requires breathing and opens that area while at the same time you’re swallowing,” Dr. Goodman said. “And then you’ll cough, because the lung doesn’t want anything going down there that doesn’t belong there, and that means [anything other than] just moisturized, warm air.”
The dental patient in Illinois claimed to have coughed when he swallowed the drill bit, but it wasn’t strong enough to get the heavy drill bit back up.