Experience with Blind Nasotracheal Intubation for Temporomandibular Joint Ankylosis at Mayo Hospital, Lahore

Abstract

Temporomandibular joint ankylosis presents a serious problem for airway management. Alternate or additional technique of airway control are required in this condition. Different options include blind nasotracheal intubation, fiberoptic intubation, retrograde intubation or tracheostomy. Moreover, the patient could be awake or asleep. The purpose of our study was to describe our experience with blind nasotracheal intubation after induction of general anesthesia with spontaneous ventilation in patients of temporomandibular ankylosis presenting for corrective surgery. This experience was gained on all the patients of temporomandibular joint ankylosis presenting to fasciomaxillary department at Mayo Hospital, Lahore over a period of 1 1/2 years. The surgery done was gap arthroplasty with genioplasty. Thirty six patients (male:24, female: 12) with age ranging between 3 years to 25 years with a mean of 12.56 years were studied. All the patients received premedication with atropine 10mg/kg body weight to dry up secretion. Patients were deeply anaesthetized with Halothane, Nitrous oxide with 50% oxygen. Thirty four patients were successfully intubated. Blind nasal intubation failed in 2 patients. The successful blind nasotracheal intubation for surgery for TMJ ankylosis needs adequately and deeply anaesthetized patients, relatively small well lubricated endotracheal tube passed through patent naris with atropine as premedication.