G Pantaleo, M Amato, C E Boschetti, C Risi and A Cortese
Accepted Abstracts: Surgery Curr Res
Introduction: Short thyromental distance (TMD; <5 cm) has been correlated with difficult direct intubation in adult patients. Differences in patient characteristics may influence the incidence of difficult airway intubation, especially in patients with a reduced mandible.Unfortunately, even careful examination does not predict every case of difficult intubation, so that unexpected problems may occur. We report acase affected by Goldenhar?s syndrome treated formandibular ipoplasyawith difficulties in intubation. Methods: A 25 years old caucasian woman was referred to the Unit of Maxillofacial Surgery of the University of Salerno, with bilateral Goldenhar?s syndrome, treated with sandwich osteotomy as ?wing? typefollowing Triaca technique with the aid of the fiberscope for airway intubation and subsequent tracheostomy. Anesthesiologists classified the airways as easy or difficult according to specified criteria ("easy" defined as a single attempt with a Macintosh 3 blade resulting in a grade 1 laryngoscopic view; "difficult" defined as >1 attempt by an operator with at least 12 months anesthesia experience, grade 3 or 4 laryngoscopic view, need for a second operator, or non-elective use of an alternative airway device). Results: The anesthesiologist?s prediction changed from easy to difficult at the time of operation, this because the patient had a severe reduction of the mandible with the position of the tongue which overlapped the epiglottis making very difficult intubation. Discussion: The patient's jaw was hypoplastic with aplasia of the temporo-mandibular joint, which led to asymmetry of the lower face and an extremely short mandible. Additionally, we observed a large tongue in relation to the small jaw. Macrostomia is part of the syndrome, and may lead to underestimation of intubation problemsand subsequent estubation for tongue swelling. Conclusions: Anesthesiologists can derive useful information from facial appearance that enhances the prediction of a difficult airway, with the aid of X-rays, TMD and a proper study of the clinical case too, particularly after mandibular osteotomies for subsequent tongue and pharyngeal swelling with airway obstruction at the extubation time.
G Pantaleois a 26 years old Postgraduate at the Department of Odontostomatological Sciences of University Federico II of Naples. He is Secretary of several international scientific societies. He is author of publications on national and international journals.
