Anesth Pain Med.  2016 Jan;11(1):113-116. 10.17085/apm.2016.11.1.113.

Successful intubation using a specially bent lighted stylet to fit the upper airway passage of a patient with ankylosis of the temporomandibular joint and deep cervical abscesses: A case report

• Park IK
• Park JH
• Kang JG
• Sohn KS
• Lee SJ

• KMID: 2169086
• DOI: http://doi.org/10.17085/apm.2016.11.1.113

Abstract

A bent lighted stylet has demonstrated effectiveness for intubating patients with difficult airways. We report a case of successful intubation using a lighted stylet that was bent to configure the upper airway passage in a patient with ankylosis of the temporo-mandibualr joint and a small inter-incisor gap with diffuse submandibular abscesses. We suppose that lighted stylets with different bends can be used in difficult airway cases. The usefulness of a bent lighted stylet to fit the upper airway passage needs further evaluation for additional clinical application.

Keyword

Instrument; Intratracheal intubation; Temporomandibular ankylosis

MeSH Terms

Abscess*
Ankylosis*
Decompression Sickness
Humans
Intubation*
Intubation, Intratracheal
Joints
Temporomandibular Joint*

Figure

• 

  Fig. 1 Transverse (A) and midline sagittal (B) computed tomography image of the patient’s head and neck. These images show he submandibular abscesses with necrotizing fasciitis displacing the larynx and upper trachea to the left with mucosal swelling inside the laryngeal cartilage at the C5 level (A), and tracheal displacement to the left with peritracheal swelling down to the C7 vertebrae level (B). Arrows indicate the deep cervical abscesses. C1: body of the first cervical vertebrae, C5: body of the fifth cervical vertebrae, HO: hyoid bone, Lx: larynx, M: mandible, T: tongue, VC: vocal cord.

• 

  Fig. 2 Preparing the UAP bent lighted stylets. The UAP bend was made following the line from inter-incisor gap to the larynx inlet on an actual size sagittal computed tomography image (A). Comparison of the conventional “J”-shaped bend (upper B) with the bend in the patient’s upper airway configuration (lower B). The UAP bend was made along the patient’s upper airway passage with 3 cm of the tip bent to parallel to the tracheal axis for ease of endotracheal tube entry through the vocal cords. C1: body of the first vertebrae, C5: body of the fifth vertebrae, LI: lower incisor, Lx: larynx, T: tongue, UAP: upper airway passage.

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