J Dent Anesth Pain Med.  2016 Dec;16(4):317-320. 10.17245/jdapm.2016.16.4.317.

Difficult airway management in a patient with a thin mandible

• Choi HS
• Oh JS
• Kim EJ
• Yoon JY
• Yoon JU
• Kim CH

• KMID: 2366162
• DOI: http://doi.org/10.17245/jdapm.2016.16.4.317

Abstract

A 47-year-old woman was referred for surgical treatment of osteomyelitis of the mandible. She had already undergone three previous surgeries. Pre-anesthetic airway evaluation predicted a difficult airway, due to the thin, retro-positioned mandible, tongue, and atrophic changes in the lips and soft tissue. We inserted packing gauzes in the buccal mucosa for easier mask fitting and ventilation. During direct laryngoscopic intubation with a nasotracheal tube (NTT), fracture of a thin mandible can easily occur. Therefore, we used a fiberoptic bronchoscope to insert the NTT. After surgery, we performed a tongue-tie to protect against airway obstruction caused by the backward movement of the tongue during recovery. The patient recovered without any complications. We determined the status of the patient precisely and consequently performed thorough preparations for the surgery, allowing the patient to be anesthetized safely and recover after surgery. Careful assessment of the patient and airway prior to surgery is necessary.

Keyword

Airway management; Edentulous jaw; Mandibular reconstruction

MeSH Terms

Airway Management*
Airway Obstruction
Bronchoscopes
Female
Humans
Intubation
Jaw, Edentulous
Lip
Mandible*
Mandibular Reconstruction
Masks
Middle Aged
Mouth Mucosa
Osteomyelitis
Tongue
Ventilation

Figure

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  Fig. 1 Panoramic view of the patient's jaw.

• 

  Fig. 2 Sagittal computed tomography view of the patient's jaw.

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