The importance of videolaryngoscopy in maxillofacial practice associated with restricted mouth opening in traumatized patients

Leonardo Alan Delanora,Nathália Januario De Araujo,William Phillip Pereira Da Silva,Leonardo Perez Faverani,Ana Paula Farnezi Bassi,Ana Maira Pereira Baggio

doi:10.33448/rsd-v10i2.12178

Leonardo Alan Delanora, Nathália Januario De Araujo + Show 4 more

Open Access

https://doi.org/10.33448/rsd-v10i2.12178

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Abstract

Orotracheal intubation is considered the most delicate maneuver performed by anesthesiologists, and failure to manage the airways is one of the main causes of possible complications that can be catastrophic during its performance, thus requiring good team planning. Anatomical and / or physiological characteristics, such as limited mouth opening, a condition often found in patients suffering from fractures of the zygomatic arch or who have some abnormality in the temporomandibular joint (TMJ), can characterize a difficult airway, which demands attention greatest of the professional. Therefore, in order to overcome the obstacles that may occur during a difficult or unexpected intubation, new tools have been used, such as videolaryngoscopy in which an intubation device containing miniature video cameras is used in order to allow the operator has an indirect view of the glottis to increase success rates and decrease intubation time. The aim of the present study is to report a clinical case of a trauma victim, with limited mouth opening, who underwent intubation with the aid of a video laryngoscope after failed attempts at conventional intubation.

Highlights

The introduction of new tools in clinical practice for intubation is necessary in order to overcome the difficulties that may appear during an intubation of patients with difficult airways (VAD) (Ciccozzi et al, 2013, Kilicaslan et al, 2014, Cunha Andrade et al, 2018)
Given this scenario, when conventional laryngoscopes are not satisfactory, videolaryngoscopy is one of the tools that can be used to facilitate intubation in the event of a difficult airway (Ciccozzi et al, 2013, Erdivanli et al, 2018, Kilicaslan et al, 2014, Apfelbaum et al, 2013, Jungbauer et al, 2009, Aziz et al, 2012) and through it, it is possible to obtain a better view of the laryngeal structures, with faster intubations and less need for optimization maneuvers through the use of video laryngoscopes (Ciccozzi et al, 2013, Kilicaslan et al, 2014, Jungbauer et al, 2009, Berkow et al, 2018, Niforopoulou et al, 2010)
Video laryngoscopes usually have a light source at the tip of their blade and a camera that projects the image in real time to a portable video system, another advantage that can be mentioned, is that they allow to abandon the need for alignment of the oral, pharyngeal and tracheal axes to receive a direct view of the glottis, which facilitates the intubation of patients with pathology or immobilization of the cervical spine (Ciccozzi et al, 2013, Erdivanli et al, 2018, Kilicaslan et al, 2014, Jungbauer et al, 2009, Aziz et al, 2012, Berkow et al, 2018, Niforopoulou et al, 2010)

Summary

Introduction

The introduction of new tools in clinical practice for intubation is necessary in order to overcome the difficulties that may appear during an intubation of patients with difficult airways (VAD) (Ciccozzi et al, 2013, Kilicaslan et al, 2014, Cunha Andrade et al, 2018). Trismus may result from mechanical impairment of the coronoid process of the mandible, impact on the masseter and temporal fascia, rupture of the fracture of the zygomatic-maxillary complex or even muscle spasms due to fracture of the zygomatic arch (Chang et al, 2012, Trindade et al, 2012, Pereira et al, 2014) Given this scenario, when conventional laryngoscopes are not satisfactory, videolaryngoscopy is one of the tools that can be used to facilitate intubation in the event of a difficult airway (Ciccozzi et al, 2013, Erdivanli et al, 2018, Kilicaslan et al, 2014, Apfelbaum et al, 2013, Jungbauer et al, 2009, Aziz et al, 2012) and through it, it is possible to obtain a better view of the laryngeal structures, with faster intubations and less need for optimization maneuvers through the use of video laryngoscopes (Ciccozzi et al, 2013, Kilicaslan et al, 2014, Jungbauer et al, 2009, Berkow et al, 2018, Niforopoulou et al, 2010). Time to a portable video system, another advantage that can be mentioned, is that they allow to abandon the need for alignment of the oral, pharyngeal and tracheal axes to receive a direct view of the glottis, which facilitates the intubation of patients with pathology or immobilization of the cervical spine (Ciccozzi et al, 2013, Erdivanli et al, 2018, Kilicaslan et al, 2014, Jungbauer et al, 2009, Aziz et al, 2012, Berkow et al, 2018, Niforopoulou et al, 2010)

Methodology

Case Report

Findings

Final Considerations