Retrospective evaluation of airway management with blind awake intubation in temporomandibular joint ankylosis patients: A review of 48 cases

Abstract

Aim:The aim was to determine the morbidity or mortality associated with the blind awake intubation technique in temporomandibular ankylosis patients.Settings and Design:A total of 48 cases with radiographically and clinically confirmed cases of temporomandibular joint (TMJ) ankylosis were included in the study for evaluation of anesthetic management and its complications.Materials and Methods:Airway assessment was done with standard proforma including Look externally, evaluate 3-3-2 rule, Mallampati classification, Obstruction, Neck mobility (LEMON) score assessment in all TMJ ankylosis patients. The intubation was carried out with the standard departmental anesthetic protocol in all the patients. The preoperative difficulty assessment and postoperative outcome were recorded.Results:Blind awake intubation was done in 92% of cases, 6% of cases were intubated by fiberoptic awake intubation, and 2% patient required surgical airway. Ninety-eight percent of the patients were cooperative during the awake intubation. The frequent complications encountered during the blind awake intubation were epistaxis and sore throat.Conclusion:In an anesthetic setup, where fiberoptic intubation is not available, blind awake intubation could be considered in the anesthetic management algorithm.

Methods of Airway securing in patients treated for temporonandibular joint ankylosis

“…The use of fiberoptic in this study is much less when compared to the study conducted in South Africa (22). Blind awake intubation was successful in majority 92% of the cases done in India (24), which is completely incomparable with our study finding only 14% were intubated by blind nasal. This lowest number of fibroptic and blind nasal intubation in our current study may be due an availability of fibroptic and lack of skilled anesthesiologist in practice of these techniques.…”

“…Fiberoptic intubation is considered as a gold standard in TMJ anklosis surgery as means of airway securing. Tracheostomy is an invasive procedure with a post-operative morbidity (15,25).…”

The Laboratory Diagnostic Profile of SARS−CoV−2 (COVID−19) Patients & Associated Factors

“…However awake fiberoptic intubation is considered as the gold standard. [3] Etio-pathogenesis of temporo-mandibular joint ankylosis TMJ ankylosis can be intra-articular or extraarticular based on location, or bony, fibrous, or fibro-osseous based on type of tissue involved and complete, or incomplete based on extent of fusion. Trauma is the most common cause of TMJ ankylosis followed by local infection or systemic infection.…”

Blind nasal intubation in temporomandibular joint ankylosis: A case report

“…Temporomandibular joint ankylosis results in restricted or nil mouth opening and jaw function get affected (Sankar et al, 2016). It is a serious and disabling condition that may cause problems in mastication, digestion, speech, appearance, and hygiene.…”

“…Facial asymmetry, deviation of mandible and chin on affected side, hypoplastic mandible with receiding chin and fullness of face on affected side are the features of unilateral TMJ ankylosis (Choudhary and Gupta, 2014;Gayle et al, 2013). The technique such as blind nasal intubation, retrograde intubation using a guide wire, intubating with the help of a fibreoptic laryngoscope, and the time tested tracheostomy have been used for a long time to manage airway (Sankar et al, 2016).…”