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Case Reports
. 2023 Apr;62(Suppl1):137-141.
doi: 10.20471/acc.2023.62.s1.18.

AWAKE FIBEROPTIC TRACHEAL INTUBATION AND AT-RISK EXTUBATION IN A PATIENT WITH ANTICIPATED DIFFICULT AIRWAY DUE TO POST-TRAUMATIC ANKYLOSIS OF TEMPOROMANDIBULAR JOINTS

Ivan Beneš  1 , Mislav Kasalo  1 , Renata Curić Radivojević  1 , Igor Blivajs  2 , Dinko Leović  2   3   4 , Andrea Peršin Beraković  1
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Case Reports

AWAKE FIBEROPTIC TRACHEAL INTUBATION AND AT-RISK EXTUBATION IN A PATIENT WITH ANTICIPATED DIFFICULT AIRWAY DUE TO POST-TRAUMATIC ANKYLOSIS OF TEMPOROMANDIBULAR JOINTS

Ivan Beneš et al. Acta Clin Croat. 2023 Apr.

Abstract

In this case report we present successful airway management in a patient with predicted difficult airway using the Difficult Airway Society guidelines. Our patient presented with recurrence of severely reduced mouth opening due to post-traumatic bilateral temporomandibular ankylosis, and was scheduled for surgical resection of the mandibular articular processes. Awake fiberoptic intubation was planned. After light sedation and thorough topicalization of the nasal cavity the flexible optic bronchoscope was successfully navigated into the trachea with 'spray-as-you-go' technique and the endotracheal tube was railroaded over it. After a two-point check of the endotracheal tube placement the patient was put under anesthesia. The surgery was uneventful. Finally, a plan with surgeons for safe extubation was made and the patient was extubated uneventfully on the next day using the airway exchange catheter in the intensive care unit.

Keywords: At-risk extubation; Awake tracheal intubation; Difficult airway; Trismus.

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Figures

Fig. 1
Fig. 1
3D reconstruction showing ankylosis before surgery.
Fig. 2
Fig. 2
3D reconstruction showing release of the joint after surgery.
See this image and copyright information in PMC

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