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Chest CT confirmed the fragment lodged in the right lower lobe bronchus. The patient was transferred to our institution, where flexible bronchoscopy successfully retrieved the 2.5\u2009cm fragment. Her cough resolved, and aside from post-thyroidectomy hypocalcaemia, her recovery was uneventful. Bougie fracture during intubation is extremely rare but should be considered in difficult airways. Early recognition, prompt imaging and bronchoscopy are crucial for management. Routine device inspection and careful procedural planning are key to preventing such complications.<\/jats:p>","DOI":"10.1136\/bcr-2025-265594","type":"journal-article","created":{"date-parts":[[2025,5,20]],"date-time":"2025-05-20T04:35:25Z","timestamp":1747715725000},"page":"e265594","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Missing piece: tracheobronchial foreign body aspiration during an elective thyroidectomy"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-9441-9575","authenticated-orcid":false,"given":"Kaiser Marr De Guzman","family":"Cruz","sequence":"first","affiliation":[{"name":"College of Medicine, University of the Philippines Manila, Manila, Philippines"},{"name":"Division of Pulmonary Medicine, Philippine General Hospital, Manila, Philippines"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gene Philip Louie Calderon","family":"Ambrocio","sequence":"additional","affiliation":[{"name":"College of Medicine, University of the Philippines Manila, Manila, Philippines"},{"name":"Division of Pulmonary Medicine, Philippine General Hospital, Manila, Philippines"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,5,19]]},"reference":[{"doi-asserted-by":"publisher","key":"2025082706460579000_18.5.e265594.1","DOI":"10.1213\/01.ane.0000237305.02465.ee"},{"doi-asserted-by":"publisher","key":"2025082706460579000_18.5.e265594.2","DOI":"10.1016\/j.ajem.2004.12.005"},{"doi-asserted-by":"publisher","key":"2025082706460579000_18.5.e265594.3","DOI":"10.1111\/anae.12534"},{"key":"2025082706460579000_18.5.e265594.4","doi-asserted-by":"crossref","first-page":"437","DOI":"10.4103\/ija.IJA_140_17","article-title":"Airway trauma during difficult intubation\u2026 from the frying pan into the fire?","volume":"61","author":"Kalingarayar","year":"2017","journal-title":"Indian J Anaesth"},{"key":"2025082706460579000_18.5.e265594.5","doi-asserted-by":"crossref","first-page":"839","DOI":"10.4103\/ija.ija_93_23","article-title":"Broken bougie: A thrilling nightmare - A case study","volume":"67","author":"Singh","year":"2023","journal-title":"Indian J Anaesth"},{"key":"2025082706460579000_18.5.e265594.6","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1016\/j.jclinane.2018.12.020","article-title":"Breaking of airway exchange device during endotracheal intubation - An avoidable catastrophe","volume":"55","author":"Mohanty","year":"2019","journal-title":"J Clin Anesth"},{"key":"2025082706460579000_18.5.e265594.7","doi-asserted-by":"crossref","first-page":"8420","DOI":"10.21037\/apm-20-2541","article-title":"Successful experience in dealing with tooth aspiration after extubation: a case report","volume":"10","author":"Jiang","year":"2021","journal-title":"Ann Palliat Med"},{"key":"2025082706460579000_18.5.e265594.8","doi-asserted-by":"crossref","first-page":"38","DOI":"10.4266\/kjccm.2014.29.1.38","article-title":"Extraction of Endobronchial Tooth by Flexible Bronchoscopy Using Fishnet Basket in Patients of Intensive Care Unit with Artificial Airway","volume":"29","author":"Kim","year":"2014","journal-title":"Korean J Crit Care Med"},{"key":"2025082706460579000_18.5.e265594.9","doi-asserted-by":"crossref","first-page":"844A","DOI":"10.1016\/j.chest.2018.08.766","article-title":"Nothing but net: successful tooth retrieval via flexible bronchoscopy","volume":"154","author":"Winsett","year":"2018","journal-title":"Chest"},{"doi-asserted-by":"crossref","unstructured":"Tammara A , Reed RM , Verceles AC . A missing tooth after intubation. BMJ Case Rep 2014;2014. doi:10.1136\/bcr-2014-207145","key":"2025082706460579000_18.5.e265594.10","DOI":"10.1136\/bcr-2014-207145"},{"doi-asserted-by":"publisher","key":"2025082706460579000_18.5.e265594.11","DOI":"10.1016\/j.jacr.2017.01.046"},{"unstructured":"Stutz EW , Rondeau B . Mallampati score. In: StatPearls. Treasure Island (FL): StatPearls Publishing, 2024. 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