Retrograde intubation in a dog with severe temporomandibular joint ankylosis: case report

Abstract

BackgroundOrotracheal intubation in dogs is a common and easily-performed procedure that provides a patent airway during anaesthesia. In dogs with temporomandibular joint ankylosis or pseudo-ankylosis, airway management can be a challenging procedure since these dogs have a limited ability to open their mouth. Methods to provide safe, uneventful intubation in such patients may include minimally invasive techniques such as retrograde intubation using a guide wire and fibre-optic-aided laryngoscopy.Case presentationWe report a case of a 16-month-old, intact female Bull Terrier weighing 17 kg, admitted to the hospital for surgical treatment of bilateral ankylosis of the temporomandibular joint. Intubation was achieved, without direct observation of the larynx, by retrograde intubation using a vascular access catheter and a vascular wire guide through cricothyroid membrane. Bilateral condylectomy was performed and the dog recovered uneventfully.ConclusionsIn conclusion, retrograde intubation was relatively simple to perform with the guide wire technique and no specific training or equipment were necessary.

Preoperative retrograde reintubation during partial tracheal resection and anastomosis in a cat with severe tracheal stenosis

“…1 Surgical resection and anastomosis are indicated for the removal of small tracheal masses, the repair of severely traumatised tracheal segments, the reconstruction of tracheal transection, the treatment of tracheal stenosis and tracheal avulsion. 12 In the present case, intraluminal dilatation was attempted as a first option with bougienage. However, since the dilatation was not successful, surgical intervention with tracheal resection of the stenosis and anastomosis of the trachea was recommended, given the young age of the patient.…”

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

“…Fibreoptic laryngoscopy is the ideal alternative for tracheal intubation of patients with restricted mouth opening because it permits the visualisation of the glottis through the oral route. However, its use is limited by the cost and availability of fibreoptic laryngoscopy (Fudge, 2015; Vieitez et al., 2018). Supraglottic airway devices offer an easy, effective and non‐invasive method of securing the airway in cats (Cassu et al., 2004), but they cannot be used in animals with restricted mouth opening.…”

“…In addition, unlike the laryngeal and cricoid cartilage, the tracheal cartilage is absent dorsally; thus, the possibility of damage to the dorsal tracheal membrane and oesophagus is more likely in a tracheal approach than when the needle is inserted through the cricothyroid membrane (Mace & Hedges, 2004). In a canine case reported in 2018, the cricothyroid membrane approach was used, as it was useful in the localisation, puncture and facilitation of the introduction of the guide (Vieitez et al., 2018). These advantages related to the cricothyroid membrane could also be observed in cats.…”

“…A few reports have described the complications of RI in human medicine, including sore throat, hypoxaemia, laryngospasm/bronchospasm, cough (American Society of Anesthesiologists Task Force on Management of the Difficult Airway, 2003), incorrect tube‐placement site, development of haematoma, procedure time greater than or equal to 3 min, pneumomediastinum (Francois & Mehdi, 2006), subcutaneous emphysema (Bowes & Johnson, 1994), infection and bleeding (Wijesinghe & Gough, 2000). However, the RI technique was shown to result in no complications in llamas (Byers et al., 2009), rabbits (Corleta et al., 1992), mice (Zhao et al., 2006) and dogs (Vieitez et al., 2018). In the present case, although a self‐limiting minor airway bleeding occurred, no further complications were noted.…”

Benefits of incorporating point of care ultrasound in the anaesthetic management of a dog requiring surgical correction of traumatic zygomatic fracture causing pseudoankylosis and severe dental malocclusion

“…14 Retrograde placement of an ETT is a well-described, simple and cheap alternative when conventional placement is not possible. [13][14][15] Fibreoptic-assisted intubation, via the oral or nasal route, was not considered in the current case due to predicted inability to pass the scope orally and the presence of nasal deviation, respectively. Retrograde intubation and tracheostomy were therefore the options the authors had in the current case.…”