Difficult Airway

2018 ◽  
Author(s):  
Paul Hopkins ◽  
Laura Ryan
Keyword(s):  
Difficult Airway ◽  
Neuromuscular Blockade ◽  
Pediatric Patient ◽  
Mouth Opening ◽  
Facial Asymmetry ◽  
Limited Mouth Opening ◽  
Mandibular Hypoplasia

The management of the difficult airway is one of the most challenging situations an anesthesiologist may encounter. The pediatric patient provides unique challenges such as lack of cooperation, rapid desaturation while apneic, and the presence of syndromes with craniofacial manifestations not frequently encountered in adults. These craniofacial manifestations may include mandibular hypoplasia, facial asymmetry, and limited mouth opening, to name a few. This chapter presents a case of a 5-year-old boy with Klippel-Feil syndrome and discusses the different aspects involved when dealing with a difficult airway in a pediatric patient, including the use of fiberoptic devices, neuromuscular blockade, and sedative premedication.

Difficult Airway

2013 ◽  
Author(s):  
Peter Howe
Keyword(s):  
Difficult Intubation ◽  
Mouth Opening ◽  
Facial Asymmetry ◽  
Treacher Collins Syndrome ◽  
Healthy Children ◽  
Limited Mouth Opening ◽  
Mandibular Hypoplasia ◽  
Obstructive Sleep ◽  
History Of ◽  
Pierre Robin

Airway management in otherwise healthy children is normally easy in experienced hands and an unexpected difficult intubation should be uncommon. Predictors of difficult intubation include mandibular hypoplasia, limited mouth opening, facial asymmetry, and a history of stridor or obstructive sleep apnea. Many of these features occur in conditions such as Treacher Collins syndrome, Goldenhar's syndrome, and the Pierre Robin sequence.

Concomitant Temporomandibular Joint Ankylosis and Maxillomandibular Fusion in a Child with Klippel- Feil Syndrome: A Case Report

2018 ◽  
Vol 42 (5) ◽  
pp. 386-390
Author(s):  
Deepika Pai ◽  
Abhay T Kamath ◽  
Pushpa Kini ◽  
Manish Bhagania ◽  
Saurabh Kumar
Keyword(s):  
Oral Health ◽  
Temporomandibular Joint ◽  
Cervical Vertebrae ◽  
Clinical Signs ◽  
Mouth Opening ◽  
Facial Asymmetry ◽  
Limited Mouth Opening ◽  
Oral Manifestation ◽  
Temporomandibular Joint Ankylosis ◽  
Joint Ankylosis

Klippel-Feil syndrome (KFS) is classically characterized by fusion of any of the two of seven cervical vertebrae. It is identified by the presence of a triad of clinical signs including short neck, limitation of head and neck movements and low posterior hairline. Unusual bony malformations leading to facial asymmetry is the most common oral manifestation associated with KFS. Such maxillomandibular fusion can also result in restricted mouth opening in children. It's a challenge to provide complete rehabilitation in such children. This paper presents a report of a type II KFS with both maxillomandibular fusion and temporomandibular joint ankylosis which led to the limited mouth opening in a six-year-old child. Also, the child showed an inadequate development of speech, facial asymmetry and compromised oral health owing to the restricted mouth opening. After thorough investigations, surgery was done which restored limited mouth opening which led to normalizing of speech and oral health.

scholarly journals ISOLATED ZYGOMATIC BONE FRACTURE

2016 ◽  
Vol 23 (05) ◽  
pp. 526-530
Author(s):  
Suneel Kumar Punjabi ◽  
Kashif Ali Channar ◽  
Munir Ahmed Banglani ◽  
Naresh Kumar ◽  
Ambreen Munir
Keyword(s):  
Maxillofacial Surgery ◽  
Mouth Opening ◽  
Facial Asymmetry ◽  
Fixation Method ◽  
Facial Bones ◽  
Limited Mouth Opening ◽  
Zygomatic Bone ◽  
Study Setting ◽  
Infraorbital Rim

Introduction: Facial bones injuries results in functional disturbances. Patientsmay presents with flattening of normal malar prominence, lid drop, eye movement limited orwith double vision, numbness of cheek area and unilateral epitasis. Emphasizing upon incisiontype, fixation method and occasionally reconstruction, surgeons suggest different methods forrepairing complex fractures of Zygoma. Study Design: Descriptive study. Setting: Departmentof Oral & Maxillofacial Surgery, Liaquat University of Medical & Health Sciences, Jamshoro.Period: Mar 2013 to Feb 2014. Materials and methods: Total 20 patients were included.Patients with fracture more than 28 days old were excluded. Zygomatic bone can be approachedby lateral brow or subcilicary incisions and by subgingival buccal sulcus approach. When 3fracture sites were reduced and aligned satisfactorily, application of miniplates was performedat 3 points frontozygomatic suture, Zygomatico maxillary buttress and infraorbital rim, woundwere closed in 2 layers. At 2nd week follow-up patients were assessed for outcome. Results:There were 14 male and 6 female patients. Most were of age <25 years. 45% fractures weredue to RTA. Duration of fracture of 2 patients was 2 days, 7 days of 11 patients, 4 patients had14 days and 3 patients had 28 days. 5 fractures were reduced using Gilies temporal approach,6 with Keen approach, 4 with Hook approach and 5 with Dingman approach. Preoperatively,17 patients had facial asymmetry, 19 had limited mouth opening and postoperatively this wasreduced to 6 cases each for facial asymmetry and limited mouth opening. Conclusion: Itis concluded from this study that three point fixation is most effective and safe method forreduction of fracture of Zygomatic bone.

scholarly journals Osteochondroma of the temporomandibular joint: a case report

2010 ◽  
Vol 21 (3) ◽  
pp. 253-258 ◽  
Author(s):  
Estevam Rubens Utumi ◽  
Irineu Gregnanin Pedron ◽  
Andréia Perrella ◽  
Camila Eduarda Zambon ◽  
Marcelo Minharro Ceccheti ◽  
...  
Keyword(s):  
Temporomandibular Joint ◽  
Mandibular Condyle ◽  
Mouth Opening ◽  
Facial Asymmetry ◽  
Contralateral Side ◽  
Limited Mouth Opening ◽  
Oral And Maxillofacial Region ◽  
Preauricular Approach ◽  
Condylar Morphology

Osteochondroma of the mandibular condyle has been found in the oral and maxillofacial region rarely. This paper describes a case of osteochondroma of the mandibular condyle in a 20-year-old woman, who was referred to our service with facial asymmetry, prognathic deviation of chin, cross-bite to the contralateral side, changes in condylar morphology, limited mouth opening, and malocclusion. Computed tomography (CT) was performed for better evaluation to the pathological conditions on the temporomandibular joint. Based on the clinical examination, patient history, and complementary exams, the hypothesis of osteochondroma was established. Condylectomy was performed using a preauricular approach with total removal of the lesion. After 3 years of postoperative follow up and orthodontic therapy, the patient is symptom-free, and has normal mouth opening with no deviation in the opening pattern.

Management of progressive facial asymmetry owing to a rare temporomandibular joint tumour: A case report

2020 ◽  
Vol 47 (2) ◽  
pp. 163-169
Author(s):  
Geetanjali Sharma ◽  
Mohammad Shorafa ◽  
Gurdeep Hans
Keyword(s):  
Case Report ◽  
Temporomandibular Joint ◽  
Male Patient ◽  
Mouth Opening ◽  
Facial Asymmetry ◽  
Temporomandibular Joint Dysfunction ◽  
Limited Mouth Opening ◽  
History Of ◽  
Slow Growing ◽  
Park Hospital

Osteochondroma of the condyle is a rare, slow-growing, benign tumour of the temporomandibular joint that can result in facial asymmetry, limited mouth opening, temporomandibular joint dysfunction and malocclusion. The large majority of osteochondromas occur at the distal metaphysis of the femur and the proximal metaphysis of the tibia, whereas only 0.6% of osteochondromas have been reported as occurring in the craniofacial region. We discuss the diagnosis and treatment of a 56-year-old fit and well male patient who presented to the Orthodontic Department at Wexham Park Hospital with a four-year history of progressive facial asymmetry and functional concerns, owing to a rare osteochondroma of the condyle.

scholarly journals Developmental features and predicting airway failure risk in critically ill children with mandibular hypoplasia using 3D computational tomographic analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Doo-Hwan Kim ◽  
Eunseo Gwon ◽  
Junheok Ock ◽  
Jong-Woo Choi ◽  
Jee Ho Lee ◽  
...  
Keyword(s):  
Risk Factors ◽  
Difficult Airway ◽  
Hyoid Bone ◽  
Three Dimensional ◽  
Upper Airway ◽  
Critically Ill Children ◽  
Healthy Controls ◽  
Mandibular Hypoplasia ◽  
Tongue Position ◽  
Developmental Features

AbstractIn children with mandibular hypoplasia, airway management is challenging. However, detailed cephalometric assessment data for this population are sparse. The aim of this study was to find risk factors for predicting difficult airways in children with mandibular hypoplasia, and compare upper airway anatomical differences using three-dimensional computed tomography (3D CT) between children with mandibular hypoplasia and demographically matched healthy controls. There were significant discrepancies in relative tongue position (P < 0.01) and anterior distance of the hyoid bone (P < 0.01) between patients with mandibular hypoplasia and healthy controls. All mandibular measures were significantly different between the two groups, except for the height of the ramus of the mandible. After adjusting for age and sex, the anterior distance of hyoid bone and inferior pogonial angle were significantly associated with a difficult airway (P = 0.01 and P = 0.02). Quantitative analysis of upper airway structures revealed significant discrepancies, including relative tongue position, hyoid distance, and mandible measures between patients with mandibular hypoplasia and healthy controls. The anterior distance of the hyoid bone and inferior pogonial angle may be risk factors for a difficult airway in patients with mandibular hypoplasia.

Severe Pain and Limited Mouth Opening Due to TMJ Chondromatosis: a Case Report

2021 ◽  
Vol 3 (5) ◽  
pp. 1227-1232
Author(s):  
Lucas Maia Nogueira ◽  
Isabela Wolf Grotto ◽  
Samuel de Souza Moraes ◽  
Fabio Ricardo Loureiro Sato ◽  
Érica Cristina Marchiori
Keyword(s):  
Case Report ◽  
Severe Pain ◽  
Mouth Opening ◽  
Limited Mouth Opening

scholarly journals Fabrication of Customized Sectional Impression Trays in Management of Patients with Limited Mouth Opening: A Simple and Unique Approach

2013 ◽  
Vol 2013 ◽  
pp. 1-4
Author(s):  
Vamsi Krishna CH ◽  
K. Mahendranadh Reddy ◽  
Nidhi Gupta ◽  
Y. Mahadev Shastry ◽  
N. Chandra Sekhar ◽  
...  
Keyword(s):  
Case Reports ◽  
Mouth Opening ◽  
Limited Mouth Opening ◽  
Significant Step ◽  
Removable Prosthesis ◽  
Unique Approach ◽  
Submucous Fibrosis ◽  
The Common ◽  
Proper Orientation

Impression making is not only important but is also the most significant step in the fabrication of any fixed or removable prosthesis. Proper impression making may be hindered by certain pathologic conditions. Reduced mouth opening is one of the common mechanical obstructions for proper orientation of the impression tray in the patient’s mouth. In patients with trismus induced by submucous fibrosis, the procedure may be even more difficult to carry out because of reduced tissue resiliency and obliteration of vestibular spaces. Use of sectional trays offers one of the alternatives to overcome the problem of restricted mouth opening. Fabrication of customized impression trays according to the patient dentition improves the accuracy of impression making. The present case reports describe the fabrication of sectional custom trays designed for dentulous patients with chronic tobacco-induced submucous fibrosis.

scholarly journals Use of Awake Flexible Fiberoptic Bronchoscopic Nasal Intubation in Secure Airway Management for Reconstructive Surgery in a Pediatric Patient with Burn Contracture of the Neck

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Tolga Totoz ◽  
Kerem Erkalp ◽  
Sirin Taskin ◽  
Ummahan Dalkilinc ◽  
Aysin Selcan
Keyword(s):  
Airway Management ◽  
Difficult Airway ◽  
Pediatric Patient ◽  
Reconstructive Surgery ◽  
Management Technique ◽  
Anesthesia Induction ◽  
Nasal Intubation ◽  
Stepwise Approach ◽  
Patient Cooperation ◽  
Trial Phase

Although the use of awake flexible fiberoptic bronchoscopic (FFB) intubation is a well-recognized airway management technique in patients with difficult airway, its use in smaller children with burn contractures or in an uncooperative older child may be challenging. Herein, we report successful management of difficult airway in a 7-year-old boy with burn contracture of the neck, by application of FFB nasal intubation in a stepwise approach, first during an initial preoperative trial phase to increase patient cooperation and then during anesthesia induction for the reconstructive surgery planned for burn scars and contractures. Our findings emphasize the importance of a preplanned algorithm for airway control in secure airway management and feasibility of awake FFB intubation in a pediatric patient with burn contracture of the neck during anesthesia induction for reconstructive surgery. Application of FFB intubation based on a stepwise approach including a trial phase prior to operation day seemed to increase the chance of a successful intubation in our patient in terms of technical expertise and increased patient cooperation and tolerance by enabling familiarity with the procedure.

Sign in / Sign up

Export Citation Format

Share Document