New Jaw Support Device and Awake Fiberoptic Intubation

Abstract

To the Editor: The jaw support device (JSD), designed to support the bilateral angle of the patient’s jaw, facilitates exposure of the larynx and maintenance of airway patency without the need for an assistant during fiberoptic intubation in anesthetized, paralyzed patients (1). The first prototype of this device, however, can be used only with the Maquet Operating Table System (MAQUET, Rastatt, Germany) and requires the manipulation of six screws (three on each side) for adjustment. To overcome these problems, we have developed a new prototype of the JSD (Arizono Orthopedic Supplies Company Ltd., Kitakyushu, Japan). This new device is attached to a stainless board, which enables it to be used on any operating table, and it is easily and quickly adjustable to fit the jaw by using the easy locking mechanism and levers (Figure 1).Figure 1: A new jaw support device supporting the bilateral angle of the jaw. The device maintains jaw thrust and head extension. Bilateral heads (A) attached to the easy-locking poles are adjustable to the desired height and direction by simply pulling up. Bilateral universal arms (B) attached to a stainless board can be fixed only by pushing the levers (C). The device may be additionally secured in place by using two screws (white arrow) on each side. The head is covered with a soft cushion that can support the angle of the jaw without discomfort, even in a conscious patient.The JSD has been used for fiberoptic intubation under general anesthesia, but it is also useful for conscious fiberoptic intubation. During fiberoptic intubation in patients with conscious sedation or deep sedation, a jaw thrust maneuver by an assistant is sometimes required (2) because pharyngeal and laryngeal structures tend to move posteriorly, which can obstruct the airway and fiberoptic view. In these sedated patients, the JSD facilitates laryngeal exposure and maintenance of airway patency without the need for an assistant. This device can be used without discomfort for conscious patients, but it should be used for a short duration to minimize the potential risk of local skin or nerve damage. We have used this device in several sedated patients who required awake fiberoptic intubation and found that it was valuable. Kazuyoshi Aoyama MD* Etsuko Nagaoka MD* Ichiro Takenaka MD† Tatsuo Kadoya MD†