1/6. ankylosis of the temporomandibular joint developing shortly after multiple facial fractures.A 41-year-old male patient was referred for treatment of extensive facial fractures and lateral condylar dislocations. The patient underwent open reduction and fixation under general anaesthesia. Intermaxillary fixation was released in 2 weeks and mouth opening was 21 mm. Despite postoperative physical exercises, the range of motion decreased to 10 mm at 5 weeks after the surgery. MR arthrography revealed a fibrous ankylosis in the bilateral TMJs. Coronal CT scans depicted a bony outgrowth of the left TMJ tuber. The patient underwent surgery for the ankylosis including discectomy and coronoidectomy, and removal of the bony outgrowth. An interincisal distance of 30 mm on maximal mouth opening has been maintained for 14 postoperative months. The importance of imaging assessment was emphasized for diagnosing the precise pathologic state of the ankylosis and selecting an appropriate surgical treatment of choice.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/6. Retrieval of a retrograde catheter using suction, in patients who cannot open their mouths.In difficulty, tracheal intubation can be facilitated by passing a retrograde catheter, but the mouth has to be opened for the retrieval of the catheter from the pharynx. Two patients with ankylosis of a temporomandibular joint were unable to open their mouth, and required general anaesthesia for gap arthroplasty. Because we did not have a flexible fibreoptic laryngoscope, we used a suction catheter to retrieve an epidural catheter from the pharyngeal cavity, which had been passed retrogradely from a cricothyroid puncture. Catheter-guided tracheal intubation was done without complication. A suction catheter can assist retrograde retrieval of a catheter to aid intubation in patients who cannot open the mouth.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
3/6. Fluoroscope-aided retrograde placement of guide wire for tracheal intubation in patients with limited mouth opening.Passing a retrograde catheter/wire into the pharynx through a cricothyroid puncture can facilitate tracheal intubation in difficult situations where either a flexible fibre-optic bronchoscope or an expert user of such a device is not available. Some mouth opening is essential for the oral and/or nasal retrieval of the catheter/wire from the pharynx. Two patients with temporo-mandibular joint (TMJ) ankylosis and extremely limited mouth opening required gap arthroplasty of the TMJ under general anaesthesia. Because we did not have a flexible fibre-optic bronchoscope, we performed fluoroscopy-assisted nasal retrieval of the guide wire passed up through a cricothyroid puncture and subsequently accomplished wire-guided naso-tracheal intubation. In the absence of a flexible fibre-optic bronchoscope, this technique is a very useful aid to intubation in patients with limited mouth opening.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
4/6. Use of a gum elastic bougie to facilitate blind nasotracheal intubation in children: a series of three cases.Management of a difficult paediatric airway is challenging, and the unavailability of a paediatric fibreoptic bronchoscope, a common limitation in developing countries, adds to these difficulties. Children with bilateral temporomandibular joint ankylosis have limited mouth opening and therefore direct laryngoscopy and intubation is not usually possible. In the absence of sophisticated fibreoptic equipment, blind nasal intubation remains the only non-surgical option for control of the airway. Blind nasal intubation in paediatric anaesthesia is difficult. We describe a novel method of blind nasal intubation in paediatric patients using a gum elastic bougie. We have used this method successfully in three patients in whom tracheal intubation using a conventional blind nasal approach was unsuccessful. In view of its reliability and the absence of any soft tissue injury, we propose the use of this novel technique as an alternative to conventional blind nasal intubation, when more sophisticated fibreoptic equipment is not available.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
5/6. ankylosis of the temporo-mandibular joint after temporal craniotomy: a cause of difficult intubation.It is not generally appreciated that surgery in the region of the temporal fossa commonly produces, within a few weeks, a contracture of the temporalis muscle with "pseudo" ankylosis of the jaw. This usually, but not always, resolves within six months. The aetiological possibilities include, singly or in combination: Postincisional scar formation within the muscle. A Volkman's contracture due to devascularization of the muscle. Organization of haematoma. It is recommended that active and passive jaw exercises be started early after surgery in the temporal fossa and that such postcraniectomy patients be carefully assessed for jaw ankylosis prior to undertaking anaesthesia.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
6/6. Extra-articular fibrous ankylosis of the mandible after zygomatic fracture.Zygomatico-coronoid fibrous ankylosis of the mandible is a complication which rarely occurs if fractures of the middle third of the facial skeleton have been adequately treated. 379 zygomatic fractures in hospitalized patients were treated at the Department of jaw Surgery of the Surgical Hospital in Helsinki between 1969 and 1975. 36 cases were characterized by convalescence being complicated by significant restriction of jaw opening. 25 patients were successfully treated by physiotherapy and 6 other by a forced opening of the jaws under general anaesthesia. In the remaining 5 cases 91.3% of the fractures) the clinically verified fibrous extra-articular ankylosis was resistant to the above mentioned conservative methods and was treated instead by intraoral coronoidectomy, supplemented in one instance by a partial myotomy of the affected masseter muscle. The importance of prophylactic physiotherapy is stressed and applies to both the post-accident and the post-corrective-operation period.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |