The bamboo skewer: Airway management in a patient with penetrating injury of the floor of mouth

Abstract

Purpose: To report a safe airway management option in patients with penetrating injury of the floor of the mouth, reinforcing the similar experience of others and illustrating the importance of proper assessment and planning before airway negotiation. Clinical features: A 23-yr-old man was admitted with a penetrating injury of the floor of mouth caused by falling on bamboo and with the foreign body in situ. The extent of penetration could not be assessed clinically but computerized tomography (CT) was used to assist in preoperative evaluation of the airway. After atropine iv, fentanyl iv, topical cocaine and lidocaine spray, awake fibreoptic guided nasal intubation was performed successfully and the patient's airway secured before induction of anaesthesia. Elective tracheostomy was performed postoperatively which was removed on day 5. Postoperative recovery was uneventful. Conclusion: Awake fibreoptic guided nasal intubation was useful in managing the airway of a patient with a penetrating injury of the floor of mouth and foreign body in situ. Thorough previous evaluation of the patient's airway by CT scan, careful topicalisation of the airway, and judicious use of iv sedation and anti-sialogue contributed to the safe and successful airway management.