Anaesthetic technique in paediatric patients with ankylosed temporomandibular joint

ABSTRACT

This study was carried out to evaluate the anaesthesia technique in 50 cases of severe trismus because of ankylosed temporo-mandibular joint. Patients managed successfully between years 1999-2002 are reported. A technique for securing the airway by blind nasal intubation, a combination of halothane, oxygen and nitrous oxide through a facemask and ventilation through a nasopharyngeal airway or nasotracheal tube was used. Increments of propofol mixed with lignocaine plain 2% were used to obtain adequate depth of anaesthesia.The technique was studied to find out the difficulties and failure rate in achieving the nasotracheal intubation. By applying gentleness in manipulation and patience, airway was secured in 1-3 attempts. Tube position was confirmed by chest auscultation and capnography. Only ten patients [20%] could be intubated in first attempt, while thirty patients [60%] could be intubated in second attempt and remaining ten [20%] in third attempt. There was no failure, no patient required preoperative tracheostomy. Adequate mouth opening was achieved in 100% cases at the end of surgery. Although we achieved a 100% success in intubation on multiple attempts, the expertise is definitely required. However the need of a fiberoptic laryngoscope cannot be overlooked