J Dent Anesth Pain Med.  2016 Dec;16(4):317-320. 10.17245/jdapm.2016.16.4.317.

Difficult airway management in a patient with a thin mandible

Affiliations
  • 1Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, Yangsan, Korea.
  • 2Department of Dental Anesthesia and Pain Medicine, Pusan National University Dental Hospital, Dental Research Institute, Yangsan, Korea. anekch@pusan.ac.kr
  • 3Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea.

Abstract

A 47-year-old woman was referred for surgical treatment of osteomyelitis of the mandible. She had already undergone three previous surgeries. Pre-anesthetic airway evaluation predicted a difficult airway, due to the thin, retro-positioned mandible, tongue, and atrophic changes in the lips and soft tissue. We inserted packing gauzes in the buccal mucosa for easier mask fitting and ventilation. During direct laryngoscopic intubation with a nasotracheal tube (NTT), fracture of a thin mandible can easily occur. Therefore, we used a fiberoptic bronchoscope to insert the NTT. After surgery, we performed a tongue-tie to protect against airway obstruction caused by the backward movement of the tongue during recovery. The patient recovered without any complications. We determined the status of the patient precisely and consequently performed thorough preparations for the surgery, allowing the patient to be anesthetized safely and recover after surgery. Careful assessment of the patient and airway prior to surgery is necessary.

Keyword

Airway management; Edentulous jaw; Mandibular reconstruction

MeSH Terms

Airway Management*
Airway Obstruction
Bronchoscopes
Female
Humans
Intubation
Jaw, Edentulous
Lip
Mandible*
Mandibular Reconstruction
Masks
Middle Aged
Mouth Mucosa
Osteomyelitis
Tongue
Ventilation

Figure

  • Fig. 1 Panoramic view of the patient's jaw.

  • Fig. 2 Sagittal computed tomography view of the patient's jaw.


Reference

1. Devlin H, Ferguson MW. Alveolar ridge resorption and mandibular atrophy. A review of the role of local and systemic factors. Br Dent J. 1991; 170:101–104.
Article
2. Klemetti E, Vainio P. Effect of bone mineral density in skeleton and mandible on extraction of teeth and clinical alveolar height. J Prosthet Dent. 1993; 70:21–25.
Article
3. Sunanda G, Rajesh S, Dimpel J. Airway Assessment: Predictors of Difficult Airway. Indian J Anaesth. 2005; 49:257–262.
4. Kollias I, Krogstad O. Adult craniocervical and pharyngeal changes- a longitudinal cephalometric study between 22 and 42 years of age. Part I: morphological craniocervical and hyoid bone changes. Eur J Orthod. 1999; 21:333–344.
Article
5. Johnston CD, Richardson A. Cephlometric changes in adult pharyngeal morphology. Eur J Orthod. 1999; 21:357–362.
6. Beresin VE, Schiesser FJ. The neutral zone in complete dentures. J Prosthet Dent. 2006; 95:93–100.
Article
7. Wright CR, Muyskens JH, Strong LH, Westerman KN, Kingery RH, Williams ST. A study of the tongue and its relation to denture stability. J Amer Dent Assoc. 1949; 39:269–275.
Article
8. Victor LD. Obstructive sleep apnea. Am Fam Physician. 1999; 60:2279–2286.
9. Murray D, Dodds C. Perioperative care of the elderly. Contin Educ Anaesth Crit Care Pain. 2004; 4:193–196.
Article
10. Nayar S, Knox J. Management of obstructive sleep apnea in an edentulous patient with a mandibular advancement splint: A clinical report. J Prosthet Dent. 2005; 94:108–111.
Article
11. Apfelgaum JL, Haqberq CA, Caplan RA, Blitt CD, Connis RT, Nickinovich DG. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology. 2013; 118:251–270.
12. Parmet JL, Colonna-Romano P, Horrow JC, Miller F, Gonzales J, Rosenberg H. The laryngeal mask airway reliably provides rescue ventilation in cases of unanticipated difficult tracheal intubation along with difficult mask ventilation. Anesth Analg. 1998; 87:661–665.
Article
13. Novak-Jankovic V. Management of the difficult airway. Acta Clin Croat. 2012; 51:505–510.
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