Methods of Airway securing in patients treated for temporonandibular joint ankylosis

Abstract

Background: - Temporomandibular joint (TMJ) is a complex structure composed of several components including glenoid fossa of the temporal bone, the condylar head of the mandible, articular disk, as well as several ligaments and associated muscles. Its ankylosis causes distressing conditions including, both functional and aesthetic problems. An anesthetic management is challenging and surgery of TMJ ankylosis falls into the category of difficult airway as direct vocal cord visualization is difficult due to an inability to open the mouth. Fiberoptic intubation is considered as a safest approach and gold standard in TMJ ankylosis surgery as means of airway securing.Objectives: - The aim of this study was to assess method of airway securing in patients treated for temporomandibular joint ankylosis at Addis Ababa University Oral and Maxillofacial surgery affiliate Hospitals. Materials and Methods: - A retrospective cross sectional study was conducted in 22 patients (n=14 male and n=11 female) with mean age of 21.7(ranged 6-50) diagnosed with temporomandibular joint ankylosis at Addis Ababa University, Oral and Maxillofacial Surgery affiliate Hospitals both Yekatit 12 Hospital medical college and St. Peter specialized Hospital. Data was collected from patients’ medical records registered in a period of 3 years from January 2017 to December 2019. EPI- INFO 7 computer software was used for data analysis. Results: - The highest incidence of ankylosis was reported between the age of 11 and 20 (40.91%). Unilateral ankylosis was reported in (59.09%) and (68.18%) was bony ankylosis based on tissue involved. In majority 17 (77%) of patients tracheostomy was used as intubation technique and securing the airway and fibroptic technique is used only in 2(9%) patients. Conclusion: - The findings of this study tracheostomy was the most commonly used intubation technique, due unavailability of fibroptic and skilled professional in practice of other intubation techniques. Institutional capacity building of facilities, increasing service availability and experts for practice of fiberoptic and bland nasal intubation technique is recommended.

Temporomandibular Joint Ankylosis: Anesthetic Challenge

“…The gold standard is a fiberoptic video laryngoscope since blind nasal intubation can damage the middle or inferior epistaxis, nasal mucosal damage, infection, and turbinate. Patient's cooperation, local blocks for the laryngeal nerves, and topical anesthetic for the upper airway are required during awake intubation [ 7 ]. When considering pediatric patients for anesthesia, it is important to keep in mind the physiological and anatomical variations that exist between an adult and pediatric patient [ 8 ].…”