Journal of Dental Anesthesia and Pain Medicine

The Korean Dental Society of Anesthsiology (대한치과마취과학회)
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Difficult airway management in a patient with a thin mandible

  • Choi, Hong-Seok (Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University) ;
  • Oh, Jong-Shik (Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University) ;
  • Kim, Eun-Jung (Department of Dental Anesthesia and Pain Medicine, Pusan National University Dental Hospital, Dental Research Institute) ;
  • Yoon, Ji-Young (Department of Dental Anesthesia and Pain Medicine, Pusan National University Dental Hospital, Dental Research Institute) ;
  • Yoon, Ji-Uk (Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital) ;
  • Kim, Cheul-Hong (Department of Dental Anesthesia and Pain Medicine, Pusan National University Dental Hospital, Dental Research Institute)
  • Received : 2016.12.16
  • Accepted : 2016.12.19
  • Published : 2016.12.31
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Abstract

A 47-year-old woman was referred for surgical treatment of osteomyelitis of the mandible. She had already undergone three previous surgeries. Pre-anesthetic airway evaluation predicted a difficult airway, due to the thin, retro-positioned mandible, tongue, and atrophic changes in the lips and soft tissue. We inserted packing gauzes in the buccal mucosa for easier mask fitting and ventilation. During direct laryngoscopic intubation with a nasotracheal tube (NTT), fracture of a thin mandible can easily occur. Therefore, we used a fiberoptic bronchoscope to insert the NTT. After surgery, we performed a tongue-tie to protect against airway obstruction caused by the backward movement of the tongue during recovery. The patient recovered without any complications. We determined the status of the patient precisely and consequently performed thorough preparations for the surgery, allowing the patient to be anesthetized safely and recover after surgery. Careful assessment of the patient and airway prior to surgery is necessary.

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