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OSCE: actor and procedure stations04 / 22

Broken front tooth after a difficult intubationActor: a 52-year-old man in recovery after elective inguinal hernia repair; an upper front tooth is broken

From memory: the diagnosis and the notes are hidden. Answer each question aloud, then press Show.

Know this first

  • Dental injury: about 1 per 2,000–3,000 general anaesthetics with a tracheal tube.
  • Tooth damage is the commonest injury behind anaesthesia malpractice claims.
  • Document it, get a dental opinion, and watch for an aspirated fragment.
  • A past difficult airway should guide every later airway plan.

The patient

Actor: a 52-year-old man in recovery after elective inguinal hernia repair; an upper front tooth is broken. Intubation was difficult and took three attempts, one by a trainee. He is angry and wants to know who is responsible. Task: explain, manage the injury and respond to his complaint.

The examiner asks

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  1. Open

    How do you open?

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    • I'm speaking to him in recovery about the front tooth broken during a difficult intubation. Patient
    • I'm the consultant anaesthetist. I can see you're upset, and I want to explain. Communication
    • First, is your mouth painful, and are you coughing or short of breath?

  2. Explain

    Explain what happened.

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    • Placing your breathing tube was much harder than expected and needed more than one try. (Communication)
    • During that, your upper front tooth broke. I'm sorry.
    • I'll check your consent notes and go through them with you.
    • We have the main piece. If any fragment is missing, you'll have a chest X-ray.
    • A broken piece can be breathed in, so I'm making sure none went into your lungs.

  3. Respond

    He says: 'I want compensation for this.'

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    • I understand why you'd ask. I can't decide compensation, but I'll tell you who does. (Communication)
    • Patient relations handle claims. Here are their details, and you can have a copy of my notes.
    • In the meantime, I'm referring you to the hospital dentist today.

  4. Respond

    He asks: 'Was it the trainee who broke it?'

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    • I was responsible for your anaesthetic and for everyone working with me. (Communication)
    • The difficulty was in your airway; the team's priority was keeping you breathing.
    • I won't single anyone out. It's my responsibility, and I'm sorry.

  5. Close

    How do you close?

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    • Because your airway was difficult, I'll give you a letter for any future anaesthetist. Communication
    • Future teams can plan for this from the start, so please keep the letter safe.
    • Here's my number, and your dental appointment before you leave.
    • I record the damage, the fragment check, the dental referral and this conversation. After surgery

Fatal mistakes

  • Not searching for a missing fragment.
  • Blaming the trainee.
  • Promising compensation.

Checked against: Barash 9e · DAS 2025

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