Korean J Anesthesiol.  2004 Dec;47(6):883-886. 10.4097/kjae.2004.47.6.883.

Difficult Intubation during Induction of a Patient with Pseudoankylosis of the Temporo-mandibular Joint after Pterional Craniotomy: A case report

• Cheong KG
• Kwak KH
• Kim SO
• Park JC

• KMID: 2032607
• DOI: http://doi.org/10.4097/kjae.2004.47.6.883

Abstract

We describe here a case of difficult intubation due to pseudoankylosis of the temporo-mandibular joint after a pterional craniotomy. A 50-year-old female was admitted to our hospital presenting with severe headache. According to her angiogram, a ruptured aneurysm in left posterior communicating artery (PCoA) and an unruptured right PCoA aneurysm were detected. We the operation in two-steps; the first operation for the left PCoA proceeded without any problem, and the tracheal intubation also was not difficult. Four weeks later, while inducing the general anesthesia for her second operation, severe trismus was detected after the infusion of propofol 120 mg. While ventilating the patient with a well-fitted mask, we performed several attempts of conventional tracheal intubation, and the patient was finally managed using a ProSealTM laryngeal mask airway with controlled ventilation. According to patient's history, trismus has also occurred after her first operation. We think that the reason for her trismus was a result of contracture of the temporalis muscle after her first pterional craniotomy.

Keyword

airway; difficult intubation; laryngeal mask; pseudoankylosis; pterional craniotomy

MeSH Terms

Anesthesia, General
Aneurysm
Aneurysm, Ruptured
Arteries
Contracture
Craniotomy*
Female
Headache
Humans
Intubation*
Joints*
Laryngeal Masks
Masks
Middle Aged
Propofol
Trismus
Ventilation
Propofol