Awake fiberoptic retromolar intubation in a patient with limited mouth opening


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Oluş F., Babun H.

Turkish Association of Oral And Maxillofacial Surgery 29th International Scientific Congress, Antalya, Turkey, 06 November 2022 - 10 August 2023, pp.137

  • Publication Type: Conference Paper / Summary Text
  • City: Antalya
  • Country: Turkey
  • Page Numbers: pp.137
  • Akdeniz University Affiliated: Yes

Abstract

Difficult airway management is one of the main challenges of anesthesia practice. Inappropriate approaches at this stage are the most important factor leading to anesthesia-related morbidity and mortality. Cases that cannot be intubated and cannot be ventilated can result in hypoxic brain damage or even death if not managed properly New intubation approaches have also been created with new tools developed to achieve success in difficult intubation. Instruments such as video laryngoscope, fiberoptic bronchoscope, and optical stylet can be used in case of difficult intubation. Many approaches such as orotracheal intubation, nasotracheal intubation, retromolar intubation, submental intubation, and tracheostomy can be preferred according to the patient and the surgical procedure to be performed. Invasive airway opening (tracheostomy) can be created, or oral or nasal intubation can be performed with a fiberoptic bronchoscope, especially in patients with limited mouth opening, due to the limited use of instruments such as laryngoscope, videolaringoscope, and optical stylet.

Case Presentation:57 years old male patient. There was temporomandibular joint ankylosis developed after trauma. There was no history of disease or medication. Inter-Incisor Gap: 1.5 cm, Neck Circumference: 41 cm, Sternomental Distance: 12 cm Thyromental Distance: 7 cm. Cervical spine mobility was normal. After applying lidocaine 10% spray to the patient's passageway, endotracheal intubation was performed by passing through the left retromolar space with a fiberoptic bronchoscope under conscious sedation. After a 4-hour interpositional gap arthroplasty and coronoidectomy operation, the patient was extubated with Cook. No complications occurred in the preoperative intraoperative and postoperative period.