LAUSR

Dr. Norman makes an interesting point. He writes that, in his own clinical practice, a throat pack is inserted during paediatric dental extractions in order to catch any tooth or bone fragments which will then be removed with the throat pack before extubation. Traditional dental anaesthesia in small children employs a gaseous induction, oxygenation is maintained with a nasal mask, patients breathe spontaneously and the teeth are extracted quickly and skilfully without the need for a throat pack, which has the potential to obstruct the airway. In older children, either a supraglottic airway device or a, preferably cuffed [1], tracheal tube is inserted. We believe that in neither situation is a throat pack necessary. In practice, the surgeon should recognise that there is a tooth or bone fragment unaccounted for and retrieve it immediately using direct vision and suction. We would argue that waiting until the end of the procedure, in the hope that a placed throat pack has caught any tooth or bone fragments, is not best practice. The alternative, as suggested by Norman, of removing any such fragments at the end of surgery by suctioning the airway under direct vision is also too late and should not be required. Although there are still some situations in which a throat pack is necessary [2], we believe that they should become increasingly rare and we hope that, by raising awareness, unintentionally retained throat packs will become a thing of the past. We thank Dr. Daunt for noticing our incorrect use of the word ‘radiolucent’ instead of ‘radio-opaque’ when describing the radiographic appearance of throat packs, their threads and tampons.