Modified retrograde intubation through the cricothyroid membrane in a cat with temporomandibular joint ankylosis

Abstract

A 6‐month‐old, 2.9‐kg, male, Korean short hair cat was referred for inadequate mouth opening (4 mm), and condylectomy was scheduled for ankylosis of the left temporomandibular joint. Retrograde intubation via the cricothyroid membrane was planned since direct visualisation of the larynx was not possible. In dorsal recumbency, the cricothyroid membrane was punctured with an 18‐gauge needle, and a J‐tip guidewire, inserted via the needle, was advanced and identified at the mouth. A 6‐Fr truncated feeding tube was inserted from the mouth to the cricothyroid membrane along the guidewire. The guidewire was removed, and the tip of the feeding tube was advanced as an anterograde guide to the inner trachea. Subsequently, an endotracheal tube was inserted along the feeding tube. Capnography was used to confirm correct intubation. Condylectomy was performed on the left temporomandibular joint, and the patient recovered from anaesthesia uneventfully. Retrograde intubation is less invasive than tracheostomy or cricothyroidotomy, and the cricothyroid membrane has been suggested as a suitable site for guidewire insertion in humans and dogs. However, when resistance is encountered during the advancement of endotracheal tube using the traditional technique without the anterograde guide, it may be difficult to distinguish where the resistance occurred leading to damage or oesophageal displacement in cats with relatively fragile airway. This report suggests that retrograde intubation via the cricothyroid membrane can be performed in cats with limited visualisation of the larynx, and an anterograde guide following the retrograde wire could reduce the potential damage or oesophageal displacement.

Pilot cadaveric study on the feasibility of cricothyroidotomy and the associated complications in 30 cats

“…One study using this CTT technique in nine live pigs did not report any hemorrhagic complications ( 12 , 13 ). One case report in feline medicine using CTM puncture for retrograde orotracheal intubation did report some bleeding during the puncture of the CTM ( 24 ). Although they have been reported in the human literature during CTT ( 25 ), they remain rare given the fibrous nature of the membrane ( 4 , 22 ).…”