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Cigarette smoke was shown to reduce the expression of some recognition molecules on the surface of alveolar macrophages, namely CD31, CD91, CD44, and CD71, which are necessary for epithelial/macrophage crosstalk and effective clearance of apoptotic cells and tissue debris [217]

This is especially likely to happen when the lighter is kept somewhere you cant regularly check

He had open surgery, where a bar and wires were inserted to hold his jaw in place during healing

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For instance, mouth-to-lung (MTL) vaping, which is similar to the way you smoke a cigarette, involves taking the vapour into your mouth before inhaling it into your lungs