Embargo: 0001H Paris time Friday 1 November
A relatively simple injection of air has proved successful in releasing a 7-year-old boy’s tongue that became entrapped in a juice bottle, says a case report published in the latest edition of the European Journal of Anaesthesiology (the official journal of the European Society of Anaesthesiology).
The technique, inspired by the author’s memory of opening a wine bottle with a similar method, means other more complex techniques involving general anaesthesia and physically cutting off the bottle from around the tongue can be avoided. The report is by Professor Christoph Eich and Dr Simone Arndt, Auf der Bult Children’s Hospital, Hannover, Germany.
Tongue entrapment in a bottle is a relatively rare emergency that usually involves children of school age who are playing with bottles using their tongue, unaware of the risk of their tongue becoming stuck. Strangulation of the front part of the tongue within the bottle neck causes accumulation of fluid (oedema), restriction of blood flow (ischaemia), capillary damage, and pain; this may put the child’s upper airway and breathing at risk.
Some authors have reported management under local anaesthesia, systemic pain relief, or sedation; others have described the use of general anaesthesia and even endoscopic intubation. Several reports have described non-invasive attempts to free an entrapped tongue. However, similar to this new case, generous lubrication followed by rotation of the bottle and pulling it were unsuccessful in all but one case, as was the release of a presumed vacuum by cutting off the bottom of the bottle or drilling holes in the bottle wall. In most cases, the bottles (glass, plastic, or metal) were physically cut.
All reported children had a severely swollen tongue after liberation from the bottle neck as well as signs of ischaemia and capillary damage. One child had to be intubated because of upper airway obstruction after the bottle was removed and remained ventilated for two days. Eventually, all children made full recoveries.
In this case reported by Eich and Arndt, the 7-year-old boy from Hannover, Germany, had been drinking juice from the bottle, and had been licking inside the bottle to try and get the last drops of the juice from it. Suddenly, the boys tongue became trapped, and his mother could not remove it. On arrival at Hannover’s Auf der Bult Children’s Hospital, the boy was in mild distress and showed drooling but had an open airway and no apparent shortness of breath. Under light intravenous sedation with midazolam and esketamine, a thin 70 mm plastic button cannula was carefully advanced between the tongue and the bottle neck, with the intent to release a presumed vacuum inside the bottle. This had no effect.
Subsequently, the cannula was connected to a combination of IV extension tubing and a 20 ml syringe. Air was then injected into the bottle, and after 60 ml of air, the swollen and discoloured tongue squeezed out of the bottle neck – slowly at first and then swiftly. To help reduce the swelling, prednisolone and ibuprofen were given and the boy was admitted to a paediatric surgical ward for a 24-hr observation period. On discharge, the swelling had largely dissipated but for about three days the front part of the tongue remained very discoloured. At follow-up 14 days after the entrapment, the tongue exhibited full recovery. (see pics below)
Professor Eich says: “We found only one previous report of a positive pressure technique similar to the one used by us in our patient. Published over 30 years ago, it obviously had largely been forgotten. In our case, the idea to attempt to inject air into the bottle to produce positive pressure was inspired by my personal recollection of successfully uncorking a wine bottle while working as an anaesthetic registrar, with the use of a syringe-and-cannula technique on an occasion when no corkscrew was available!”
He concludes: “Use of positive pressure proved to be a simple, effective, and safe technique for releasing a tongue entrapped in a bottle. We would suggest that this method warrants attempt before more invasive procedures under general anaesthesia are considered.”
For link to full embargoed paper, click here
Notes to editors:
There are some photos of this case below. The child’s parents have given full consent to publication of the photos.
Click to see the photos:
And when recovered
Selected media coverage