Airway management of a child with temporomandibular joint an
Now open: Certificate Course in Management of Covid-19 by Govt. Of Gujarat and PlexusMDKnow more...Now open: Certificate Course in Management of Covid-19 by Govt. Of Gujarat and PlexusMDKnow more...
Temporomandibular joint (TMJ) ankylosis in children results in severe restriction of mouth opening and abnormal facial skeletal growth. Obstructive sleep apnea (OSA) develops in longstanding cases as the size of oral and pharyngeal space also decreases secondarily. Such patients present difficulty in airway management.Managing difficult intubation with limited available resources can be challenging. We report airway management of such a child.An 8-year-old male child weighing 18 kg scheduled for TMJ ankylosis release had inter-incisor gap of 2 mm only on mouth opening. Other features included a presence of micrognathia, missing lower incisor, receding chin, and nasal septum deviation toward the right. Computed tomography scan confirmed TMJ involvement.The airway management in this patient was difficult because of several reasons. The child was noncooperative; hence, awake intubation and airway blocks were not possible. Sedation, though generally avoided in a difficult airway, may be required in noncooperative patient. On sedation, hypoxia developed as the child also had obstructed sleep apnea. His mouth opening was negligible.Inhalational induction preserved spontaneous ventilation and allowed rapid recovery on discontinuation but increased the obstruction in this patient. Hence, sevoflurane had to be stopped and airway blocks were quickly given before recovery from sedation...

http://bit.ly/2upPV30
Dr. S●●●●●r S●●●●a and 2 other likes this
Like
Comment
Share