Surgical release for intubation purposes in postburn contractures of the neck

Abstract

Postburn contractures of the neck can cause difficult endotracheal intubation when cervical hyperextension and lifting of the mandible are impaired. Alternative techniques to direct laryngoscopy may be hampered by the presence of rigid scar tissue which obscures the mandibular and laryngeal anatomy, or by the presence of microstomia following retraction of scar tissue in facial burns. This report describes our experience with a safe and quick surgical neck release to facilitate endotracheal intubation in such cases. Following release, intubation was established at the first attempt in all cases. Patients who have suffered flame burns to the thorax with an ascending involvement of the neck and mandibular region are particularly prone to develop extreme contractures. Problems with intubation should be anticipated in patients with healed burns of the neck, and equipment for aiding intubation should be on hand. Furthermore, the surgeon must be available during the induction of anaesthesia to perform an emergency neck release if necessary.