A case of pharyngeal/cervical trauma due to an epileptic attack during brushing of the teeth

Herein, we report a case of pharyngeal/cervical trauma sustained due to an epileptic attack that developed while the patient was brushing her teeth. The patient was a 20-year-old woman with schizophrenia and epileptic psychosis, who was hospitalized at a local psychiatric hospital. She lost consciousness while brushing her teeth and fell down. A toothbrush was observed in the pharyngeal cavity and the patient was transported to our hospital for emergency treatment. The toothbrush was visualized by endoscopy; the brush side of the toothbrush was embedded in the right piriform sinus and the handle side had migrated into the pharynx. CT revealed subcutaneous and mediastinal emphysema and the brush located beside the right brachiocephalic artery. An emergency operation was performed on the same day; a tracheotomy was initially performed under intravenous anesthesia, followed by removal of the pharyngeal/cervical foreign body through a cervical incision under general anesthesia. The toothbrush had penetrated the right piriform sinus and reached the right brachiocephalic artery along the right common carotid artery. The tracheal fistula was closed on the 11th day after surgery, with oral intake by the patient resumed on the 25th day, and the patient transferred to the hospital psychiatric ward on the 41st postoperative day. It might be difficult to provide medical care smoothly for adults with severe mental illness.