Guiding Flexible-Tipped Bougie Under Videolaryngoscopy: An Alternative to Fiberoptic Nasotracheal Intubation in Maxillofacial Surgeries

Abstract

Background Maxillofacial surgeries are known to have difficulty in airway management due to anatomical and functional reasons. Tumors of maxillofacial region and diseases of TM joint limit mouth opening as well as airway space. Various methods have been tried with success for nasotracheal intubation including fiberoptic-aided as well as blind nasal and light-guided intubation. Video laryngoscopy-assisted intubation uses visualization of glottis without the need of alignment of all the three axes of airway. Purpose Video laryngoscopy is being considered to increase the success rate in various different setups including critical care, pre-hospital and operating rooms. Flexible-tipped bougie guided by a video laryngoscope was used in patients with limited airway space undergoing maxillofacial surgery. Methods In present study, airway of five patients posted for various maxillofacial surgeries was secured by passing flexible-tipped bougie through the nasopharyngeal airway and, once under the view of a McGrath videolaryngoscope, was advanced toward the glottis; the rotation of the bougie with the required flexion of the tip helped a quick redirection of bougie to enter the larynx at an angle. Results Our experience of five cases with anticipated difficult intubation normally judged to be manageable with fiberoptic bronchoscopic intubation were managed without awake fiberoptic bronchoscopy using flexible-tipped bougie under vision of videolaryngoscopy. All patients were successfully managed with this technique. Conclusion Flexible-tipped bougie could take the direction toward glottis under a videolaryngoscope in an anticipated difficult airway, making a place for airway management in patients with limited mouth opening.

The Performance of Flexible Tip Bougie™ in Intubating Simulated Difficult Airway Model

“…The curve of the FTB resembles the anatomical airway curvature, thus facilitating its insertion into the hypopharynx region. This curvature can further be manipulated to swivel using the slider tab which provides further anterior and posterior movement of the tip and along with rotation, producing a 360 • rotation aiding intubation, as reported in a case series (17). The FTB also has a bright phosphorous coating on its tip to enhance the bougie tip visibility to the intubator.…”

Evaluation of intubating adjuncts to videolaryngoscopy in a simulated difficult airway: A manikin cross-over study

“…3 This flexible tip bougie has further been found to be useful in negotiating the curves of the airway via the nasal route in patients undergoing maxillofacial surgery. 4 We aimed to evaluate intubator performance with three different adjuncts to intubation with a videolaryngoscope: a Frova intubating introducer (Cook Medical, Bloomington, IN, USA); the flexible tip bougie (Construct Medical, Melbourne, Victoria, Australia); and a flexible bronchoscope (Ambu aScope, Ballerup, Denmark), used without the video screen. The latter two of these devices are able to be steered by the intubator during the intubation attempt.…”