Oro-dentale Verletzungen während der Intubationsnarkose

Abstract

Injuries to the oro-dental tissue are still one of the most frequent mishaps during endotracheal intubation and general anaesthesia. However, damage to the soft and hard tissues in most cases involves oral structures already showing advanced pathogenic alterations. Injuries to the teeth are therefore rather more often due to the disease of the teeth than to mistakes during anaesthesia. The risk of injuries to the teeth can be ascertained by means of a presurgical inspection of the oral cavity and evaluation of the individual anatomical conditions in the head and neck region, which may well interfere with the endotracheal intubation. In contrast to anaesthetic pitfalls causing severe disturbance of general health, dental trauma can be treated with quite satisfying functional and aesthetic results. However, in order to maintain conditions for the complete restitution of injured teeth immediate dental therapy is recommended. In preterm infants which need mechanical ventilation during the postnatal period direct laryngoscopy as well as mechanical alterations caused by an oral tube can cause injuries to the tooth germs of the first and second dentition and deformation of the maxillary skeleton. In consequence the patient will need intensive therapy of the resulting disturbances for several years. This review gives information about the causes and types of injuries to the oral and maxillofacial region during general anaesthesia. In addition, the anatomical conditions and pathological changes associated with an increased risk for oro-dental injuries and the facilities for prevention are discussed. Finally, the main aspects of emergency treatment of injuries to the dental hard tissues are presented.

Indirekte Laryngoskopie

“…Bei der endotrachealen Intubation mit Macintosh-Spatel sind Zahnschäden am Patienten mit einer Häufigkeit von 0,04-12% beschrieben [19]. Durch die oft notwendige Anteflexion des Unterkiefers kann es beim Einsatz eines herkömm-lichen Laryngoskops mit Macintosh-Spatel auch zu einer Schädigung des Kiefergelenks kommen [33].…”

Nasotracheale Intubation mittels Larynxmaske und Fiberbronchoskop (NILB)

“…Die einzige Kontaktaufnahme zu den Zähnen im Rahmen der NILB ist lediglich während dem Einführungsvorgang der Larynxmaske gegeben. Da es hierbei zu keiner direkten Krafteinwirkung auf die Zähne kommt, ist auch hierfür die NILB deutlich mit Vorteilen behaftet [4,8].…”

Evaluation of dental injury following endotracheal intubation using the Periotest® technique

“…The maxillary incisors (in particular the upper left central incisor) are most frequently involved (3). Fracture of crowns and roots of natural teeth (44.8%), followed by partial luxation (20.8%) and avulsion (20.8%) are known to be the most common traumas (5).…”

“…Dental trauma is the commonest single reason for lawsuits against anesthetists (1). In literature, the incidence of occurrence of dental trauma, notably damage to the maxillary incisors associated with anesthesia range widely from 1:1000 to 1:10 (3)(4)(5)(6)(7). An increased risk is seen in cases exhibiting factors predisposing to dental trauma.…”