Abstract
Ameloblastoma is a benign tumor that arises from odontogenic epithelium. It may present a challenge to anaesthetists as it can distort the facial contours and can make bag-mask ventilation difficult. We present a first case of ameloblastoma in our hospital where a 38-year-old female was scheduled for a right mandibulectomy and reconstruction of the mandible with a custom-made titanium implant. Awake fiberoptic intubation was planned as a first choice for induction of anaesthesia as any other technique may have led to serious airway complications. We believe that airway management in difficult airway cases should always be based on the principle of “burning no bridges”.
Highlights
Ameloblastoma is a benign intermittent growing tumor that affects the mandible more than the maxilla and occurs especially in the molar-ramus area (Figure 1).It is normally nonfunctional and unicentric
Case Report We present a case of a 38-year-old female patient with a huge swelling over the right lower maxilla and mandible. (Figure 2) The histological diagnosis was of benign ameloblastoma
Other options for induction of general anaesthesia could have included awake video-laryngoscopy, and laryngoscopy following an inhalational induction of anaesthesia with slightly more risks in comparison to awake fiberoptic intubation
Summary
Ameloblastoma is a benign intermittent growing tumor that affects the mandible more than the maxilla and occurs especially in the molar-ramus area (Figure 1).It is normally nonfunctional and unicentric. She had a past medical history of hypertension and was compliant with her antihypertensive treatment On airway examination, she had a large swelling on the right side of the face with adequate mouth opening and was classified as Mallampati grade 2. Awake fiberoptic intubation is helpful in recognizing any potential difficulty caused by distortion secondary to the tumor. In this patient, other options for induction of general anaesthesia could have included awake video-laryngoscopy, and laryngoscopy following an inhalational induction of anaesthesia with slightly more risks in comparison to awake fiberoptic intubation. (Figure 3) On the day of surgery, patient was pre-medicated with glycopyrrolate 0.2mg intravenously to reduce oral secretions but no sedation was used throughout the fiberoptic intubation as we did not want to take any risk of a compromised airway. The patient was transferred to the intensive care unit and was extubated day
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