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

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.

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Acute Awake Fiberoptic Intubation in the ICU in a Patient with Limited Mouth Opening and Hypoxemic Acute Respiratory Failure

Case Reports in Anesthesiology ◽

10.1155/2019/6421910 ◽

2019 ◽

Vol 2019 ◽

pp. 1-5

Author(s):

Kjartan E. Hannig ◽

Rasmus W. Hauritz ◽

Christian Jessen ◽

Anders M. Grejs

Keyword(s):

Radiation Therapy ◽

Head And Neck Cancer ◽

Mouth Opening ◽

Fiberoptic Intubation ◽

Limited Mouth Opening ◽

Emergency Airway ◽

Hypoxemic Acute Respiratory Failure ◽

Feasible Option ◽

Difficult Airways ◽

Awake Fiberoptic Intubation

The incidence and survival of patients with head-and-neck cancer have been on the increase for decades. Following surgery or radiation therapy, complications such as difficult airways may evolve. These difficult airways may be unique and not manageable with conventional intubation methods as well as video laryngoscopes. Acute awake fiberoptic intubation may be a feasible option also for urgent emergency airway management of known difficult airways. The “cannot intubate–cannot oxygenate” (CI–CO) situation has to be avoided at all costs, since emergency cricothyrotomy has a fail ratio of more than 50% when performed by an anesthesiologist.

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Use of McGrath<sup>®</sup> MAC Video Laryngoscope for Nasotracheal Intubation in Patients for Whom Intubation Was Expected to Be Difficult Due to the Limited Mouth Opening

Open Journal of Anesthesiology ◽

10.4236/ojanes.2018.87023 ◽

2018 ◽

Vol 08 (07) ◽

pp. 223-227

Author(s):

Aiji Sato ◽

Naoko Tachi ◽

Yoko Okumura ◽

Mayumi Hashimoto ◽

Masahiro Yamada ◽

...

Keyword(s):

Nasotracheal Intubation ◽

Mouth Opening ◽

Video Laryngoscope ◽

Limited Mouth Opening

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Difficult Airway

10.1093/med/9780199764495.003.0016 ◽

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.

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"Truview PCD-video laryngoscope aided nasotracheal intubation in case series of orofacial malignancy with limited mouth opening"

Journal of Anaesthesiology Clinical Pharmacology ◽

10.4103/0970-9185.155162 ◽

2015 ◽

Vol 31 (2) ◽

pp. 256 ◽

Cited By ~ 1

Author(s):

KalpanaRajendra Kulkarni ◽

RajaramShankar Patil ◽

SamratSukumar Madanaik ◽

ArchitaRajaram Patil

Keyword(s):

Nasotracheal Intubation ◽

Mouth Opening ◽

Case Series ◽

Video Laryngoscope ◽

Limited Mouth Opening

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The importance of videolaryngoscopy in maxillofacial practice associated with restricted mouth opening in traumatized patients

Research Society and Development ◽

10.33448/rsd-v10i2.12178 ◽

2021 ◽

Vol 10 (2) ◽

pp. e12010212178

Author(s):

Leonardo Alan Delanora ◽

Ana Maira Pereira Baggio ◽

Nathália Januario de Araujo ◽

William Phillip Pereira da Silva ◽

Leonardo Perez Faverani ◽

...

Keyword(s):

Clinical Case ◽

Mouth Opening ◽

Orotracheal Intubation ◽

Video Laryngoscope ◽

Intubation Time ◽

Success Rates ◽

Trauma Victim ◽

Limited Mouth Opening ◽

Video Cameras ◽

Team Planning

Orotracheal intubation is considered the most delicate maneuver performed by anesthesiologists, and failure to manage the airways is one of the main causes of possible complications that can be catastrophic during its performance, thus requiring good team planning. Anatomical and / or physiological characteristics, such as limited mouth opening, a condition often found in patients suffering from fractures of the zygomatic arch or who have some abnormality in the temporomandibular joint (TMJ), can characterize a difficult airway, which demands attention greatest of the professional. Therefore, in order to overcome the obstacles that may occur during a difficult or unexpected intubation, new tools have been used, such as videolaryngoscopy in which an intubation device containing miniature video cameras is used in order to allow the operator has an indirect view of the glottis to increase success rates and decrease intubation time. The aim of the present study is to report a clinical case of a trauma victim, with limited mouth opening, who underwent intubation with the aid of a video laryngoscope after failed attempts at conventional intubation.

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Fiberoptic Intubation as a Boon in Limited Mouth Opening Surgeries

World Journal of Dentistry ◽

10.5005/jp-journals-10015-1112 ◽

2011 ◽

Vol 2 (4) ◽

pp. 350-352

Author(s):

Sunil Dutt ◽

Salman Basha

Keyword(s):

Case Report ◽

General Anesthesia ◽

Difficult Intubation ◽

Mouth Opening ◽

Orotracheal Intubation ◽

Fiberoptic Intubation ◽

Present Case Report ◽

Limited Mouth Opening ◽

Temporomandibular Joint Ankylosis ◽

Joint Ankylosis

ABSTRACT Surgery of temporomandibular joint ankylosis under general anesthesia poses a great challenge to anesthesiologists. This surgery falls in the category of difficult intubation as direct vocal cord visualization is difficult due to an inability to open the mouth. The present case report suggests that the fiberoptic intubation has become an essential skill for anesthetists dealing with patients in whom orotracheal intubation is anatomically difficult.

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A fiberoptic orotracheal intubation successfully performed using a modified Guedel airway in a sedated emergency patient - A case report -

Anesthesia and Pain Medicine ◽

10.17085/apm.20030 ◽

2020 ◽

Vol 15 (3) ◽

pp. 378-382

Author(s):

Jaeyoung Yang ◽

Seonjin Kim ◽

Bousung Lee ◽

Kwanghaeng Lee ◽

Dongseok Kim ◽

...

Keyword(s):

Mouth Opening ◽

Emergency Operation ◽

Orotracheal Intubation ◽

Fiberoptic Intubation ◽

Male Body ◽

Emergency Patient ◽

Limited Mouth Opening ◽

Airway Assessment ◽

Safe Technique ◽

Longitudinal Channel

BackgroundAn airway assessment is usually best performed before an elective operation. But in an emergency operation, proper airway assessment can often be difficult. Fiberoptic intubation is a powerful and safe technique to deal with airway difficulty, but it requires a lot of training to be able to perform correctly. There are various specialized oral airways for fiberoptic intubation, but none of them have perfect functionality.CaseA 75-year-old male (body weight 71.6 kg, height 159.3 cm, body mass index 28.22 kg/m2) was diagnosed with acute appendicitis, and it was decided to do a laparoscopic appendectomy. After the induction of general anesthesia, it was impossible to insert the direct laryngoscope deep enough for vocal cord visualization without damaging the teeth because of limited mouth opening. We successfully performed fiberoptic intubation with a newly modified Guedel airway via a longitudinal channel on the convex side and a distal opened lingual end.ConclusionsOur modified Guedel airway can be useful in assisting fiberoptic intubation in unexpectedly difficult airway situations.

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Awake fi beroptic intubation of a patient with amyotrophic lateral sclerosis: case report

Journal of Health Sciences ◽

10.17532/jhsci.2012.44 ◽

2012 ◽

Vol 2 (3) ◽

pp. 236-237

Author(s):

Elif Bakı ◽

Elif Buyukerkmen ◽

Yüksel Ela ◽

Serdar Kokulu ◽

Remziye Sıvacı

Keyword(s):

Intensive Care Unit ◽

Amyotrophic Lateral Sclerosis ◽

Intensive Care ◽

Motor Neurons ◽

Amyotrophic Lateral Sclerosis Patient ◽

Mouth Opening ◽

Fiberoptic Intubation ◽

Limited Mouth Opening ◽

Volume Controlled Ventilation ◽

Lateral Sclerosis

Amyotrophic Lateral Sclerosis is a rapidly progressive disease from the fi fth to sixth decades of life causing degeneration and death of the upper and lower motor neurons and no effective treatment. The diagnosis isdependent on the clinical presentation and consistent electrodiagnostic studies. Progressive denervation affects the muscles, causing muscular weakness and atrophy, when the ventilation muscles are affected deathdue to respiratory failure occurs within a few years. We present the case of a 54 years old, 180 cm height and 94 kg weight male patient with amyotrophic lateral sclerosis who underwent surgical treatment of thyroidcancer. Fiberoptic intubation was orally performed providing spontaneus breathing. Propofol was applied after passing vocal cords. Anesthesia was maintained with sevofl orane (%2) and a mixture of oxygen and airunder volume controlled ventilation. Rocuronium was used 20 mg at the beginning of the surgery. At the end of surgery, he wasn’t extubated and transferred to anesthesia intensive care unit. He was extubated after tenhours and he was awaked perfectly. The patient was discharged from intensive care unit after 24 hours and from hospital after ten days. We reported that amyotrophic lateral sclerosis patient with limited mouth opening who underwent thyroid surgery, using awake intubation.

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Use of the Bonfils Intubation Fiberscope in Patients with Limited Mouth Opening

Case Reports in Anesthesiology ◽

10.1155/2012/297306 ◽

2012 ◽

Vol 2012 ◽

pp. 1-3 ◽

Cited By ~ 2

Author(s):

Nabil A. Shollik ◽

Sami M. Ibrahim ◽

Ahmed Ismael ◽

Vanni Agnoletti ◽

Emanuele Piraccini ◽

...

Keyword(s):

Ductal Carcinoma ◽

Mouth Opening ◽

Radical Mastectomy ◽

Cost Effective ◽

Neck Extension ◽

Limited Mouth Opening ◽

First Case ◽

Surgical Tracheotomy ◽

The Right ◽

Midline Approach

Airway management of patients with very limited mouth opening remains a challenge for the anaesthetist. We describe the use of the Bonfils Intubation Fiberscope for awake intubation in two patients with a very limited mouth opening. In the first case, a 60-year-old 80 kg female, scheduled for a right modified radical mastectomy for infiltrating ductal carcinoma (15 mm mouth opening, a short thick neck, limited neck extension, and a Mallampati class 4 airway), the Bonfils was advanced via the retromolar technique. In the second patient, a 34-year-old male, scheduled for a surgical tracheotomy for right tonsillar cancer, due to a neoplastic infiltration of the right temporomandibular joint (7 mm mouth opening and limited neck movement), the Bonfils was advanced using the midline approach. The Bonfils is a reusable, rigid, straight fiberoptic device with a curved tip, is 5 mm in diameter, and has several advantages: it is quick and easy to use, more cost effective than a flexible fiberscope, and is safe in expert hands, thanks to its smaller diameter. Our conclusion is that awake BIF intubation is a reliable, atraumatic, and well-tolerated procedure to secure a safe airway in patients with a limited mouth opening.

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