Airway management of patients with temporomandibular joint disorder: A 12-year retrospective review in ABUTH Zaria

Abstract

Background: Temporomandibular joint (TMJ) ankylosis is a condition associated with restricted mouth opening. Following induction of general anesthesia, airway obstruction may occur leading to “can't ventilate and can't intubate scenario.” The anticipation of difficult airway and choice of appropriate intubation techniques usually prevent anesthetic morbidity and mortality. Patients and Methods: Both the surgeons' and the anesthetic review, as well as the anesthetic chart of the 36 patients managed at Ahmadu Bello University Teaching Hospital between January 2006 and December 2017, were studied. Data collected were bio-data of the patients, extent of mouth opening, and the techniques of intubation used. Results: The mean age of the patients was 26.9 ± 1.64, with a male to female ratio of 1:1.1. There were more male 19 (52.8%) than female 17 (47.2%). Tracheal intubation was achieved with the aid of nasal fiberoptic technique in 22 (61.1%) patients, 8 patients (22.2%) were intubated by tracheostomy, 4 patients (11.1%) were intubated by blind nasal intubation, while 2 patients (5.6%) required endotracheal intubation through conventional oral laryngoscopy. The interincisor gap was between 0 and <1 cm in all the patients which indicated significantly restricted mouth opening, with an average of zero interincisor gap. Conclusion: Fiberoptic intubation was the most used approach of achieving tracheal intubation in patients with TMJ disorder.