MUMS THE WORD: UNSPOKEN COMPLICATIONS OF INTUBATION

Abstract

SESSION TITLE: Medical Student/Resident Procedures Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Intubation is one of the most common and basic procedures performed in intensive care units and other emergent settings. Some of the more well-known potential complications include direct airway injury, soft tissue injury, lacerations, bleeding, and vocal cord paralysis. Patients with intubation related injury can increase their hospital cost by 20% and lengthen their hospital stay by at least one day compared to those who did not have an intubation related injury (Pacheco-Lopez 1006). Here we will discuss a more rare potential complication of intubation. CASE PRESENTATION: The patient was a 79 year old male with a past medical history of multiple strokes, cardiomyopathy and tobacco use. He was admitted to the hospital after a mechanical fall. X-ray of his left hip showed a femoral neck fracture. Patient underwent successful left hip ORIF by orthopedic surgery. Following surgery, patient complained of dysarthria, facial droop and inability to eat. With concern for stroke, a stat CT head was obtained showing no acute findings. Three days later, an x-ray of the mandible showed bilateral anterior mandible dislocations. Patient was transferred to another facility for oral maxillary surgery for reduction of his mandible. DISCUSSION: Mandible dislocation during intubation is an unusual occurrence, but providers and even radiologists should be aware of this possible complication. It is often overlooked, and treatment can be delayed. Our patient’s hospital stay was increased by three days due to lack of prompt diagnosis clinically and on imaging. He required transfer to another facility for oral maxillary surgery. A conscious patient with temporomandibular joint (TMJ) dysfunction most often presents with an inability to close the mouth, salivation, impaired speech and a depression that is palpable in the preauricular area. Anterior and anteromedial dislocations are the most common types (Chung 75). The exact prevalence of mandibular dislocation after intubation is unknown, however several studies have shown TMJ dysfunction occurs in at least 5% of cases after intubation (Pillai 243). CONCLUSIONS: Prompt diagnosis and treatment of mandibular dislocation due to intubation is essential to prevent long term sequelae due to this complication. Providers should be aware and vigilant in diagnosing and treating this condition should it present post intubation. Reference #1: Paulette C Pacheco-Lopez, Lauren C Berkow, Alexander T Hillel and Lee M Akst. “Complications of Airway Management.” Respiratory Care (June 2014): 1006-1021. Reference #2: Sang-Bong Chung, Hyoungbae Jeon, and Taikwan Kim. “Unrecognized Bilateral Dislocation of Temporomandibular Joint during Orotracheal Intubation.” Journal of Trauma and Injury (2015): 75-78. Reference #3: Konia, Suri Pillai and Mojca Remskar. “ Unrecognized bilateral temporomandibular joint dislocation after general anesthesia with a delay in diagnosis and management: a.” Journal of Medical Case Reports (2013): 243. DISCLOSURES: No relevant relationships by Haytham Adada, source=Web Response no disclosure on file for Mahmoud Amarna; No relevant relationships by Camelia Chirculescu, source=Web Response No relevant relationships by Beverly Smith, source=Web Response No relevant relationships by Sana Yakoob, source=Web Response