Abstract
Introduction: Mandibular surgeries, edentulous mandible, use of dentures, and aging all predispose to residual mandibular ridge resorption and thinning. The edentulous state of the mandible makes the tongue occlude the upper airway. All these, contribute to difficulty in managing the airway. An adequate pre-operative review helped classify this index patient as high risk for difficult airway and adequate steps were taken to facilitate optimal airway management.Case report: We present a 53 years old woman with mandibular deformity, anterior neck mass and inadequate mouth opening who has had a segmental mandibulectomy and a soft tissue closure of reconstruction plate. She was scheduled for mandibular reconstruction.She was successfully intubated using a size 4.5 Intubating Laryngeal Mask Airway (ILMA) through which a size 6.0 ID classic endotracheal tube was introduced for ventilation. A gum elastic bougie was then inserted through the endotracheal tube, both the ILMA and classic endotracheal tube were withdrawn. An armored tube size 6.5 ID was then rail roaded.Conclusion: The successful anaesthetic management of this difficult airway patient was facilitated by a thorough pre-anaesthetic plan, concise and skilled anaesthetic management strategy with a well organized team work.
Highlights
INTRODUCTIONMandibular ridge resorption may occur due to old age, previous mandibular surgeries, an edentulous mandible, use of dentures, trauma, tumor excision and others. [1, 2] The resorption of the alveolar ridge influences the anatomical height of the mandible and it is more extensive in patients using dentures. [3] Failure to identify predictable causes of a difficult airway and incorporate the findings in the management strategy can herald a poor anaesthetic outcome. [4] This case report presents a case of mandibular ridge resorption with edentulous mandible which puts the patient at high risk for difficult airway
Mandibular surgeries, edentulous mandible, use of dentures, and aging all predispose to residual mandibular ridge resorption and thinning
Mandibular ridge resorption may occur due to old age, previous mandibular surgeries, an edentulous mandible, use of dentures, trauma, tumor excision and others. [1, 2] The resorption of the alveolar ridge influences the anatomical height of the mandible and it is more extensive in patients using dentures
Summary
Mandibular ridge resorption may occur due to old age, previous mandibular surgeries, an edentulous mandible, use of dentures, trauma, tumor excision and others. [1, 2] The resorption of the alveolar ridge influences the anatomical height of the mandible and it is more extensive in patients using dentures. [3] Failure to identify predictable causes of a difficult airway and incorporate the findings in the management strategy can herald a poor anaesthetic outcome. [4] This case report presents a case of mandibular ridge resorption with edentulous mandible which puts the patient at high risk for difficult airway. [4] This case report presents a case of mandibular ridge resorption with edentulous mandible which puts the patient at high risk for difficult airway. A likely difficult airway was predicted based on the patient’s age, the mandibular defect with exposed plate, edentulous mandible, inadequate mouth opening and an anterior neck mass. Face mask placement was difficult because of the mandibular defect, the edentulous state of the mandible and protrusion of the reconstruction plate. The faulty laryngoscope was withdrawn, face mask was reapplied, patient was ventilated and oxygen saturation was maintained at 100 %. Intravenous propofol at a dose of 150mg and suxamethonium at 100mg was repeated Another Macintosh laryngoscope with a size 4 blade was introduced and neither the epiglottis nor the larynx was again visualized (Cormack and Lehane Grade 4). She was successfully intubated, surgery was performed and she was discharged on the 6th day after surgery
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