Management of difficult airway in a pregnant patient with severely reduced mouth opening

2020 ◽  
pp. 1-8
Author(s):  
Faisal Shamim ◽  
Aly Bahadur ◽  
Dinaz Gandhi ◽  
Anum Aijaz
Keyword(s):  
Difficult Airway ◽  
Third Molar ◽  
Mouth Opening ◽  
Upper Airway ◽  
Neck Region ◽  
Pregnant Patient ◽  
Odontogenic Infections ◽  
Dental Abscess ◽  
Life Threatening ◽  
Risk Of Aspiration

Abstract Pregnancy is associated with a wide variety of oral and dental changes ranging from gingivitis to odontogenic infections. If left untreated, severe dental abscess can progress to Ludwig’s angina, which is a potentially lethal cellulitis that rapidly extends to the neck region and may lead to life-threatening upper airway obstruction. We report the case of a pregnant woman who presented with intense throbbing pain, trismus and severely reduced mouth opening due to dental abscess for the last one week. She required incision and drainage of abscess with extraction of third molar under general anaesthesia. There are some significant challenges to anaesthesiologist like the risk of aspiration and failed intubation in patients with pregnancy and anticipated difficult airway. With counselling and proper preparation, we were able to manage this case with awake intubation.  Continuous...

scholarly journals Anaesthesia for Reconstruction Surgery Post Mandibulectomy in a Patient with a Predicted Difficult Airway: A Case Report

2021 ◽  
Vol 8 ◽  
Author(s):  
Omolola Adunni Fagbohun ◽  
Ibifuro Dennar ◽  
Olugbusi Sope ◽  
Oresanwo Theressa
Keyword(s):  
Difficult Airway ◽  
Endotracheal Tube ◽  
Mouth Opening ◽  
Upper Airway ◽  
Index Patient ◽  
Anaesthetic Management ◽  
Neck Mass ◽  
Team Work ◽  
Intubating Laryngeal Mask Airway ◽  
Edentulous Mandible

Introduction: Mandibular surgeries, edentulous mandible, use of dentures, and aging all predispose to residual mandibular ridge resorption and thinning. The edentulous state of the mandible makes the tongue occlude the upper airway. All these, contribute to difficulty in managing the airway. An adequate pre-operative review helped classify this index patient as high risk for difficult airway and adequate steps were taken to facilitate optimal airway management.Case report: We present a 53 years old woman with mandibular deformity, anterior neck mass and inadequate mouth opening who has had a segmental mandibulectomy and a soft tissue closure of reconstruction plate. She was scheduled for mandibular reconstruction.She was successfully intubated using a size 4.5 Intubating Laryngeal Mask Airway (ILMA) through which a size 6.0 ID classic endotracheal tube was introduced for ventilation. A gum elastic bougie was then inserted through the endotracheal tube, both the ILMA and classic endotracheal tube were withdrawn. An armored tube size 6.5 ID was then rail roaded.Conclusion: The successful anaesthetic management of this difficult airway patient was facilitated by a thorough pre-anaesthetic plan, concise and skilled anaesthetic management strategy with a well organized team work.

scholarly journals Severe Odontogenic Infections during Pregnancy and Related Adverse Outcomes. Case Report and Systematic Literature Review

2021 ◽  
Vol 6 (2) ◽  
pp. 106
Author(s):  
Resi Pucci ◽  
Andrea Cassoni ◽  
Daniele Di Carlo ◽  
Marco Della Monaca ◽  
Umberto Romeo ◽  
...  
Keyword(s):  
Pregnancy Outcomes ◽  
Pregnant Patient ◽  
Adverse Outcomes ◽  
Cesarean Sections ◽  
Review Of The Literature ◽  
Odontogenic Infections ◽  
Life Threatening ◽  
The Mean ◽  
Adverse Pregnancy ◽  
Dental Infections

Odontogenic infections have the potential to develop into deep-space infections and may cause severe diseases with possible life-threatening complications. Dental infections during pregnancy require special attention in terms of possible complications and treatments due to the potential to affect the lives of two individuals. A case of a 36-year-old pregnant patient with a submandibular abscess caused by an odontogenic infection is reported, followed by a comprehensive systematic review of the literature in order to retrieve information regarding severe odontogenic infections and adverse pregnancy outcomes. The review was conducted according to the PRISMA guidelines using PubMed, Scopus, and Google Scholar databases. A total of 69 cases were included in the qualitative analysis. The mean age was 27.72 years. Patients were managed with surgery in combination with antibiotics. Nine infectious-related cesarean sections were detected, and preterm birth was associated in 3 cases, low birth weight in 2 cases, death of the fetus in 9 cases (13%), and maternal death in 4 cases (5.8%). The possible compromise of oral health during pregnancy is well known; however, severe odontogenic infections are rarely considered in the literature, and they may be associated with severe and life-threatening complications for both mother and the fetus.

scholarly journals Severe Life Threatening Maxillofacial Infection in Pregnancy Presented as Ludwig's Angina

2006 ◽  
Vol 2006 ◽  
pp. 1-4 ◽  
Author(s):  
Shelly Abramowicz ◽  
Jacques S. Abramowicz ◽  
M. Franklin Dolwick
Keyword(s):  
Upper Airway ◽  
Pregnant Patient ◽  
Patient Case ◽  
Incision And Drainage ◽  
Life Threatening ◽  
Ludwig’S Angina ◽  
The One ◽  
Associated Spaces ◽  
Teeth Extraction ◽  
Ludwig's Angina

Background. Ludwig's angina is a rapidly spreading cellulitis that may produce upper airway obstruction often leading to death. There is very little published information regarding this condition in the pregnant patient. Case. A 24-year old black female was admitted at 26 weeks gestation with tooth pain, submandibular swelling, severe trismus, and dysphagea, consistent with Ludwig's angina. Her treatment included emergent tracheostomy, incision and drainage of associated spaces, teeth extraction, and antibiotic therapy. Conclusions. During a life threatening infectious situation such as the one described, risks of maternal and fetal morbidity include both septicemia and asphyxia. Furthermore, the healthcare provider must consider the risks that the condition and the possible treatments may cause the mother and her unborn child.

A dangerous cause of airway obstruction: deep neck infection

2020 ◽  
Keyword(s):  
Airway Obstruction ◽  
Upper Airway ◽  
Deep Neck Infection ◽  
Jugular Vein Thrombosis ◽  
Neck Infection ◽  
Vein Thrombosis ◽  
Lethal Complications ◽  
Life Threatening ◽  
Fascial Spaces ◽  
Emergency Doctors

Deep neck infection (DNI) is an infection in the fascial spaces of the neck. Complications of DNI, including mediastinitis, internal jugular vein thrombosis, and upper airway obstruction, are severe and potentially life threatening. Therefore, early identification and accurate management of DNI are essential. We review the anatomy of the deep spaces of the neck to determine the route of DNI spread so that emergency doctors, physicians, and otorhinolaryngologists can quickly recognize the development of lethal complications of DNI, such as asphyxia from airway obstruction.

scholarly journals To Establish A Normal Range of Inter-Incisal Opening - A Study of 756 Subjects of Age Group 20-50 Years in Yamunanagar City, Haryana.

2013 ◽  
Vol 01 (01) ◽  
pp. 001-003
Author(s):  
Aruna Singh ◽  
Nymphea Pandit ◽  
Monica Sharma
Keyword(s):  
Pearson Correlation ◽  
Mouth Opening ◽  
Clinical History ◽  
P Value ◽  
Age Group ◽  
Male Population ◽  
Female Population ◽  
Odontogenic Infections ◽  
Anterior Teeth ◽  
Average Maximum

Abstract Aim- 1. The aim of this study was to investigate the average maximum range of inter-incisal mouth opening in a representative sample of the adult subjects of Haryana. 2. To see any correlation between maximal inter-incisal opening with age. Methods- Maximum mouth opening was studied in 756 adult subjects with age range of 20-50 years in Yamunanagar, Haryana. Age limit was further divided into three groups (20-30, 31-40, 41-50). Those with clinical history of TMJ involvement, OSMF, any trauma, odontogenic and non-odontogenic infections, dental prosthesis on the anterior teeth, congenital anomalies in the maxillofacial region were excluded from this study. The measurements were recorded twice and mean of the two values were taken. Statistical Analysis- Independent sample t-test was calculated to compare age and mouth opening in both male and females respectively. Bivariate pearson correlation was used to see any relationship between age and mouth opening. P-value ≤ 0.05 and CI (confidence interval) at 95% were considered statistically significant. The Results- The average mouth opening of males (45.36±6.70 mm) subjects was higher as compared to female (41.27 ± 6.75 mm) with significant, p-value 0.000. The mean mouth opening ± SD for both sexes combined was 43.39 ± 7.02 mm. The corresponding values for mean inter-incisal opening in male population aged 20-30, 31-40, 41-50 were 45.52 ± 7.15, 46.16 ± 5.47, 42.96 ± 6.82 mm and in female population aged 20-30, 31-40, 41-50 were 41.40 ± 7.08, 41.60 ± 6.29 and 40.03 ± 6.38 mm respectively. Conclusion- Maximal mouth opening differ significantly with gender. There is a decrease in MMO with older age group.

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.

scholarly journals Multidisciplinary management of the pregnant patient in haemorrhagic shock secondary to an undiagnosed ruptured liver adenoma

2020 ◽  
Vol 13 (2) ◽  
pp. e231995
Author(s):  
Brittany Sanford ◽  
Catherine Hoeppner ◽  
Tammy Ju ◽  
Brian K Theisen ◽  
Anna BuAbbud ◽  
...  
Keyword(s):  
General Surgery ◽  
Case Reports ◽  
Hepatocellular Adenoma ◽  
Multidisciplinary Care ◽  
Exploratory Laparotomy ◽  
Pregnant Patient ◽  
Haemorrhagic Shock ◽  
Liver Adenoma ◽  
Life Threatening ◽  
Temporary Closure

Management of a ruptured hepatocellular adenoma during pregnancy is a rare and potentially life-threatening entity. Few case reports have described management of the pregnant patient who presents in haemorrhagic shock secondary to a ruptured liver adenoma. A 30-year-old primigravid woman at 31 weeks pregnant presented with abdominal pain and fetal bradycardia. After stat caesarean delivery of the infant, she had continued hemoperitoneum and was in shock secondary to an undiagnosed ruptured liver mass. General surgery was consulted intraoperatively and performed an exploratory laparotomy, packing and temporary closure. She was subsequently taken to interventional radiology (IR) for angioembolisation of the left hepatic artery. After stabilisation, she underwent formal abdominal closure. Management of a ruptured hepatocellular adenoma in pregnancy requires urgent multidisciplinary care including obstetrics gynaecology, general surgery and IR.

scholarly journals Acute upper airway obstruction as a life-threatening complication of ventral bulla osteotomy: report of two consecutive cases

2021 ◽  
Vol 7 (1) ◽  
pp. 205511692110059
Author(s):  
Michal Vlasin ◽  
Richard Artingstall ◽  
Barbora Mala
Keyword(s):  
Airway Obstruction ◽  
Clinical Signs ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Single Session ◽  
Inflammatory Polyp ◽  
Case Summary ◽  
First Case ◽  
Life Threatening

Case summary This paper presents two cases of acute postoperative upper airway obstruction following ventral bulla osteotomy (VBO) in cats. The first cat underwent a unilateral left-sided VBO for a suspected inflammatory polyp. The second cat underwent a single-session bilateral VBO procedure for bilateral otitis media. In the first case, immediate re-intubation and a gradual lightening of the anaesthetic plane resolved the clinical signs; in the second case, the patient deteriorated and went into acute cardiorespiratory arrest and received cardiopulmonary resuscitation. Both patients recovered well and were discharged home 3 days after surgery. Both cases were reported to show no further clinical signs on postoperative follow-up 3 weeks and 4 months after surgery, respectively. Relevance and novel information Upper airway obstruction should be regarded as a potential complication of VBO in cats.

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