Anaesthetic Management of Temporomandibular Joint Ankylosis without Fibrotic Bronchoscope- A Review of 31 Cases

Abstract

Introduction: Temporomandibular joint (TMJ) ankylosisis acondition associated with limited to zero mouth opening. In addition to facial asymmetry, malocclusion, anemia& malnutrition, airway obstruction may be present. All these changes make not only intubation but ventilation also difficult. Method: In this article we wantto report anaesthetic management of 31 patients having temporomandibular joint ankylosis by using blind nasal intubation technique. In all patients mouth opening is either zero or less than 5mm. Observation: In 87.09% patients we could intubate by blind nasotracheal intubation technique while 13.91% patients required tracheostomy. Conclusion: Blind nasal intubation, fiber optic guided nasal intubation, retrograde intubation &tracheostomy are the different techniques of securing airway in these patients. With proper preoperative preparation, induction with inhalationalagent & blind nasal technique for intubation we can manage patients of temporomandibular joint ankylosis successfully. Blind nasal intubation technique can be mastered by practice & is useful in managing difficultintubation cases particularly when fibrotic bronchoscope is not available Key words: TMJ ankylosis, blind nasal intubation, fiber optic intubation, retrograde intubationtracheostomy.