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.

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.

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.

Difficult Laryngoscopy/Intubation: The Child with Mandibular Hypoplasia

1983 ◽  
Vol 92 (4) ◽  
pp. 401-404 ◽  
Author(s):  
Steven D. Handler ◽  
Thomas P. Keon
Keyword(s):  
Temporomandibular Joint ◽  
Direct Laryngoscopy ◽  
Anterior Commissure ◽  
Difficult Laryngoscopy ◽  
Treacher Collins Syndrome ◽  
Pierre Robin Sequence ◽  
Hemifacial Microsomia ◽  
Mandibular Hypoplasia ◽  
Pierre Robin ◽  
Infants And Young Children

The child with mandibular hypoplasia (Treacher Collins syndrome, Pierre Robin sequence, hemifacial microsomia, etc) presents the otolaryngologist and anesthesiologist with considerable problems when direct laryngoscopy and/or endotracheal intubation is attempted. In addition to the small mandible, several other features of these patients contribute to the difficult laryngoscopy: macroglossia, glossoptosis, trismus related to temporomandibular joint abnormalities, and prominent maxilla or maxillary incisors. Most of the techniques that have been described for laryngoscopy/intubation in problem cases are difficult or impossible to use in infants and young children with mandibular hypoplasia. We present a modification of the standard direct laryngoscopic procedure, utilizing the 9-cm anterior commissure laryngoscope and an optical stylet in the task of exposing and intubating the larynx of a child with mandibular hypoplasia.

scholarly journals Functional and Aesthetic Outcome Following Simultaneous Temporomandibular Joint Ankylosis Release and Correction of Chin Discrepancy by Lower Border Osteotomy-A Case Report

2021 ◽  
pp. 439-442
Author(s):  
Datarkar AN ◽  
Anukula H ◽  
Walke D ◽  
Deshpande A ◽  
Rai A
Keyword(s):  
Case Report ◽  
Temporomandibular Joint ◽  
Mouth Opening ◽  
Facial Asymmetry ◽  
Tmj Ankylosis ◽  
Facial Disfigurement ◽  
Quality Life ◽  
Old Adult ◽  
Osteotomy Technique ◽  
History Of

This is a case report of a 19 year old adult female with facial asymmetry secondary to right Temporomandibular Joint (TMJ) ankylosis with a history of previous surgery at the age of 10 years with gap arthroplasty for tmj ankylosis which was unsuccessful and lead to relapse .Because of decreased mouth opening and facial disfigurement patient was not able to have a quality life. She reported to our department where she got operated simultaneously for tmj ankylosis with interpositional arthroplasty using temporalis myofascial flap and novel osteotomy technique for correction of chin asymmetry. After surgery there is a significant improvement in patient both functionally and aesthetically.

scholarly journals Treatment of Atypical Bifid Mandibular Condyle Associated with Ankylosis of the Temporomandibular Joint

2019 ◽  
Vol 2019 ◽  
pp. 1-8
Author(s):  
Katheleen Miranda ◽  
André Sander Carneiro ◽  
Jennifer Tsi Gerber ◽  
Suyany Gabriely Weiss ◽  
Leandro Eduardo Klüppel ◽  
...  
Keyword(s):  
Temporomandibular Joint ◽  
Treatment Plan ◽  
Mandibular Condyle ◽  
Mouth Opening ◽  
Facial Asymmetry ◽  
Lateral Deviation ◽  
Tmj Ankylosis ◽  
History Of ◽  
The Right

Introduction. The bifid mandibular condyle (BMC) is an unusual temporomandibular joint (TMJ) disorder with controversial etiology. The association of this entity with ankylosis is rare. Objective. The objective of the present study is to report a case of BMC with associated TMJ ankylosis in a patient with no history of trauma and/or infection. Case Report. A 17-year-old male patient sought care reporting pain on the right TMJ region and mastication difficulty due to a severe limitation of mouth opening. In the clinic and imaging examinations, a 15 mm mouth opening and BMC associated with ankylotic mass of the right TMJ were observed, besides a facial asymmetry with chin deviation to the right. The proposed treatment plan was condylectomy on the right side, bilateral coronectomy, and genioplasty, so the chin lateral deviation could be corrected, under general anesthesia. The patient remains under clinical and imaging follow-up of two years with functional stability and no signs of relapse of the ankylosis. Conclusion. The association of BMC with ankylosis is an atypical entity which must be diagnosed and treated early to prevent aesthetic and functional damages to the patient.

Simple Technique for Tracheocutaneous Fistula Closure in the Pediatric Population

2003 ◽  
Vol 112 (1) ◽  
pp. 17-19 ◽  
Author(s):  
Debbie A. Eaton ◽  
Orval E. Brown ◽  
David Parry
Keyword(s):  
Pediatric Population ◽  
Tertiary Care ◽  
Pulmonary Infiltrate ◽  
Senior Author ◽  
Treacher Collins Syndrome ◽  
Fistula Tract ◽  
Small Leak ◽  
Obstructive Sleep ◽  
History Of

To review our experience with cauterization of persistent tracheocutaneous fistulas in children, we performed a retrospective review of patients who underwent cauterization of tracheocutaneous fistulas by the senior author (O.E.B.) from 1986 to 2001 in an academic, tertiary care children's hospital. We studied 13 pediatric patients ranging in age from 2.5 to 17.5 years of age at the time of surgery. Twelve patients underwent cauterization under endoscopic visualization. One patient underwent superficial cauterization of the tract without endoscopy. All patients had at least a 1-year history of an indwelling tracheotomy. All patients were decannulated at least 1 year before fistula cauterization. Of the 12 patients who underwent intraoperative airway endoscopy, the internal orifice of the fistula tract was specifically visualized and seen to be patent in 10. One patient was noted to have internal mucosalization of the tract, and no discrete opening to the trachea was noted in the other patient. Eleven patients had complete closure of the fistula site at follow-up (range, 2 weeks to 2 years). One patient developed a leak during a coughing spell 2 days after the operation, and the fistula was noted to be closing with a small leak at follow-up. Another patient (with Treacher Collins syndrome) ultimately required a repeat tracheotomy for persistent obstructive sleep apnea. This patient was the only one admitted after the operation, for a pulmonary infiltrate. No other patients required airway support in the immediate postoperative period. Cauterization of tracheocutaneous fistulas in children is a relatively simple, effective, and safe technique.

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 Difficult Airway Management in a Patient With Nicolaides-Baraitser Syndrome Who Had a Small Jaw and Limited Mouth Opening

2020 ◽  
Vol 68 (1) ◽  
pp. 47-49
Author(s):  
Saori Taharabaru ◽  
Takehito Sato ◽  
Kimitoshi Nishiwaki
Keyword(s):  
Genetic Disorder ◽  
Mouth Opening ◽  
Video Laryngoscope ◽  
Treacher Collins Syndrome ◽  
Fiberoptic Intubation ◽  
Facial Features ◽  
Limited Mouth Opening ◽  
Oral Intubation ◽  
First Case ◽  
Difficult Airways

Nicolaides-Baraitser syndrome (NCBRS) is a rare congenital genetic disorder characterized by distinctive facial features similar to Treacher Collins syndrome (TCS). We report the first case of successful nasal fiberoptic intubation in a patient with NCBRS with micrognathia and limited mouth opening due to trismus. A 9-year-old girl with NCBRS and dental caries was scheduled to undergo general anesthesia for a dental extraction. Initial attempts at oral intubation using a video laryngoscope were unsuccessful. However, subsequent attempts at nasal intubation using a flexible fiberoptic scope were successful. This report highlights that patients with NCBRS may present with difficult airways to manage and intubate.

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.

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