Anesthetic management of a large mandibular odontogenic myxoma in a child - a case report

Abstract

Numerous neoplastic lesions can arise in the orofacial region in the pediatric populations. Odontogenic tumors typically affect the mandible more than the maxilla. Airway management can be challenging in pediatric oral tumors because of the distorted anatomy and physiological variations. Conventional awake fiberoptic intubation is not always possible owing to limited cooperation from the pediatric populations. Herein, we report the case of a 1-year-old child with odontogenic myxoma of the mandible and an anticipated difficult airway. Given the expected difficulties in the airway, video laryngoscope-assisted orotracheal intubation under general anesthesia with maintenance of spontaneous breathing was scheduled. Proper planning and thorough examinations are vital for successful airway management in pediatric patients.

Keywords: Airway Management; Intubation; Myxoma; Odontogenic Tumors.

Fig. 1. Odontogenic myxoma protruding from the lower jaw and occupying almost entire mouth opening. A) antero-posterior view B) lateral view

Fig. 2. A large multiseptate cystic/lytic lesion involving the mandible. It is compressing and pushing the floor of mouth and tongue upward against hard and soft palate, thereby causing oropharyngeal compromise. (yellow arrows) A) coronal and B) sagittal sections of contrast enhanced computed tomography image

Fig. 3. Preparation for extubation with nasopharyngeal airway and tongue tie.

Fig. 4. Postoperative image of the patient just before discharge.