[The use of bronchial fibroscopy for difficult intubations in maxillofacial surgery]. / Utilizzazione del fibroscopio bronchiale nelle intubazioni difficili in chirurgia maxillofacciale.

BACKGROUND: Evaluation of difficulties and modalities of tracheal intubation in maxillofacial surgery. DESIGN: retrospective study. SETTING: maxillofacial operation room. 2152 patients who underwent elective maxillofacial surgery during a five-year time, from 1994 to 1998. Indications and alternative modalities of tracheal intubation through fiberoptic bronchoscope in eight patients (0.37%) with preoperatively evaluated difficult intubation due to temporomandibular ankylosis (3 patients), burns sequelae (1 patient), craniofacial congenital malformations (2 patients), unstables fractures of the cervical spine (2 patients), are discussed. Fiberoptic bronchoscope was used through nasotracheal route under topical nasal and laryngeal anaesthesia, combined with appropriate benzoanalgesia, in order to maintain spontaneous breathing. Proper positioning of tracheal tube was directly checked by fiberoptic bronchoscope, through visualization of the tracheal carina. RESULTS: In seven patients tracheal intubation was easily performed without complications in less than 20 minutes. In the eight patients the time spent was 35 minutes, due to important nasal bleeding, which caused a change of the nostril. CONCLUSION: Among the alternative methods of elective tracheal intubation, previously evaluated as difficult or impossible using conventional laryngoscopy, the use of fiberoptic bronchoscope seems to be safest and easiest to use, although not the cheapest.

[Endoscopic diagnosis of the temporomandibular joint]. / Diagnostica endoscopica dell'articolazione temporo-mandibolare.

Clinical and radiographic examinations of the temporo-mandibular joint are difficult to perform. Alternative diagnostic methods, for example, double contrast arthrotomography, computerized tomography, magnetic resonance imaging, and arthroscopy raise hopes for improved diagnostic accuracy. The purpose of this paper is to review and evaluate the potentials and limitations of this new technique.