Retrograde intubation through nasal route in patients with limited mouth opening undergoing oral and maxillofacial surgery

Background: Patients with limited mouth opening (LMO) often associated with difficult intubation. Retrograde intubation is an alternative technique of establishing definitive airway in these patients when blind nasal intubation fails and fiberoptic bronchoscope is not available. We tested the retrog...

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Main Authors: Ashwant Kumar Vadepally, Ramen Sinha, A.V.S.S. Subramanya Kumar
Format: Article
Language:English
Published: Elsevier 2018-01-01
Series:Journal of Oral Biology and Craniofacial Research
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Online Access:http://www.sciencedirect.com/science/article/pii/S2212426817301549
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author Ashwant Kumar Vadepally
Ramen Sinha
A.V.S.S. Subramanya Kumar
author_facet Ashwant Kumar Vadepally
Ramen Sinha
A.V.S.S. Subramanya Kumar
author_sort Ashwant Kumar Vadepally
collection DOAJ
description Background: Patients with limited mouth opening (LMO) often associated with difficult intubation. Retrograde intubation is an alternative technique of establishing definitive airway in these patients when blind nasal intubation fails and fiberoptic bronchoscope is not available. We tested the retrograde intubation through nasal route in patients with LMO less than 2 cm. Materials and methods: The procedure was performed with some modification with regard to retrograde guide on 18 patients requiring maxillofacial surgical procedures to increase mouth opening. Indications for this technique were mandibular fracture (n = 6), oral submucous fibrosis (OSMF; n = 6), temporomandibular joint (TMJ) ankylosis (n = 4) and internal derangement of TMJ (n = 2). All patients were assessed for preoperative interincisal opening; during intubation through specific parameters and; also postoperative findings were observed. Results: Mean time taken for successful intubation was 5.6 min ± 1.66. One patient had subcutaneous emphysema which was managed conservatively. Postoperatively, four patients had sore throat which resolved in few days. No other complications were encountered. Conclusion: In conclusion, retrograde nasotracheal intubation is an effective and useful technique for airway control in patients with LMO and with only a small risk potential.
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spelling doaj-art-3507d121a0c64b05abff51b8df8b5b9c2024-11-23T06:27:25ZengElsevierJournal of Oral Biology and Craniofacial Research2212-42682018-01-01813034Retrograde intubation through nasal route in patients with limited mouth opening undergoing oral and maxillofacial surgeryAshwant Kumar Vadepally0Ramen Sinha1A.V.S.S. Subramanya Kumar2Department of Oral and Maxillofacial Surgery, Sri Sai College of Dental Surgery, Vikarabad, Telangana, India; Corresponding author at: Plot no: 31, Street no: 8, Habsiguda, Hyderabad, Telangana, India.Department of Oral and Maxillofacial Surgery, Sri Sai College of Dental Surgery, Vikarabad, Telangana, IndiaDepartment of anesthesia, Sri Sai College of Dental Surgery, Vikarabad, Telangana, IndiaBackground: Patients with limited mouth opening (LMO) often associated with difficult intubation. Retrograde intubation is an alternative technique of establishing definitive airway in these patients when blind nasal intubation fails and fiberoptic bronchoscope is not available. We tested the retrograde intubation through nasal route in patients with LMO less than 2 cm. Materials and methods: The procedure was performed with some modification with regard to retrograde guide on 18 patients requiring maxillofacial surgical procedures to increase mouth opening. Indications for this technique were mandibular fracture (n = 6), oral submucous fibrosis (OSMF; n = 6), temporomandibular joint (TMJ) ankylosis (n = 4) and internal derangement of TMJ (n = 2). All patients were assessed for preoperative interincisal opening; during intubation through specific parameters and; also postoperative findings were observed. Results: Mean time taken for successful intubation was 5.6 min ± 1.66. One patient had subcutaneous emphysema which was managed conservatively. Postoperatively, four patients had sore throat which resolved in few days. No other complications were encountered. Conclusion: In conclusion, retrograde nasotracheal intubation is an effective and useful technique for airway control in patients with LMO and with only a small risk potential.http://www.sciencedirect.com/science/article/pii/S2212426817301549IntubationLimited mouth openingMaxillofacial surgeryNasotrachealRetrograde Intubation
spellingShingle Ashwant Kumar Vadepally
Ramen Sinha
A.V.S.S. Subramanya Kumar
Retrograde intubation through nasal route in patients with limited mouth opening undergoing oral and maxillofacial surgery
Journal of Oral Biology and Craniofacial Research
Intubation
Limited mouth opening
Maxillofacial surgery
Nasotracheal
Retrograde Intubation
title Retrograde intubation through nasal route in patients with limited mouth opening undergoing oral and maxillofacial surgery
title_full Retrograde intubation through nasal route in patients with limited mouth opening undergoing oral and maxillofacial surgery
title_fullStr Retrograde intubation through nasal route in patients with limited mouth opening undergoing oral and maxillofacial surgery
title_full_unstemmed Retrograde intubation through nasal route in patients with limited mouth opening undergoing oral and maxillofacial surgery
title_short Retrograde intubation through nasal route in patients with limited mouth opening undergoing oral and maxillofacial surgery
title_sort retrograde intubation through nasal route in patients with limited mouth opening undergoing oral and maxillofacial surgery
topic Intubation
Limited mouth opening
Maxillofacial surgery
Nasotracheal
Retrograde Intubation
url http://www.sciencedirect.com/science/article/pii/S2212426817301549
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AT ramensinha retrogradeintubationthroughnasalrouteinpatientswithlimitedmouthopeningundergoingoralandmaxillofacialsurgery
AT avsssubramanyakumar retrogradeintubationthroughnasalrouteinpatientswithlimitedmouthopeningundergoingoralandmaxillofacialsurgery