Korean J Crit Care Med.  2002 Jun;17(1):34-37.

Difficult Endotracheal Intubation Due to Unrecognized Dysfunction of Temporomandibular Joint: A case report

• Kang BJ

Abstract

In association with facial trauma, fracture of mandibular condyle occurs frequently. From that injury, the dysfunction of temporomandibular joint and the following limitation of mouth opening causing difficult intubation can result. So the anesthesiologists should have the capability of recognizing such problems. But in the case of facial trauma, pain and muscle spasm also cause similar but reversible conditions posing difficulty in differential diagnosis. In this case the patient showed some degree of limitation in mouth opening (1 finger breath) at the preoperative evaluation, so the author performed routine induction expecting the occurrence of full mouth opening after muscle relaxation. But the patient's mouth couldn't be opened any further and the exposure of epiglottis was impossible. Now since we have no reliable predictive criteria of irreversible temporomandibular joint dysfunction, awake fiberoptic intubation should be strongly considered in the case of condylar fracture with any limitations in mouth opening.

Keyword

Intubation, Tracheal: difficult; temporomandibular joint

MeSH Terms

Diagnosis, Differential
Epiglottis
Fingers
Humans
Intubation
Intubation, Intratracheal*
Mandibular Condyle
Mouth
Muscle Relaxation
Spasm
Temporomandibular Joint*