Nasal Endotracheal Intubation under Fibreoptic Endoscopic Control in Difficult Oral Intubation, Two Pediatric Cases of Submandibular Abscess.

Abstract

Securing an airway in children with trismus is challenging and dangerous. Sound clinical judgment is critical for timing and for selecting the method for airway intervention. We present two pediatric cases of submandibular abscess with difficult oral intubation who underwent incision and drainage. Large facial (jaw) swelling, trismus-limited mouth opening, edema, protruding teeth, and altered airway anatomy makes airway management more difficult. Chances of rupture of abscess intraorally and aspiration under General Anesthesia (GA) is a major threat. Loss of airway under muscle relaxation, difficult to ventilate, difficult to intubate and unwillingness for awake intubation in the pediatric age group makes these cases most challenging. On the basis of our experience, both cases were successfully intubated in anaesthetized, spontaneously breathing children with visual-guided fibreoptic intubation.