Difficult Intubation in Patient with Short Thyromental Distance: Usefulness of Tongue Traction Maneuver
- *Corresponding Author:
- Giuseppe Pantaleo
Department of Neurosciences
Reproductive and Odontostomatological Sciences
University of Naples Federico II
Via S. Pansini 5, 80131 Naples, Italy
E-mail: [email protected]
Received date: October 09, 2014; Accepted date: December 23, 2014; Published date: December 29, 2014
Citation: Cortese A, Pantaleo G, Gargiulo M, Amato M (2014) Difficult Intubation in Patient with Short Thyromental Distance: Usefulness of Tongue Traction Maneuver. J Anesth Clin Res 5:491. doi: 10.4172/2155-6148.1000491
Copyright: © 2014 Cortese A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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 dimension. We report a case affected by Goldenhar’s syndrome treated for mandibular hypoplasia with 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, planned for a sandwich osteotomy as “chin-wing” mentoplasty following Triaca technique with the aid of the tongue traction maneuver in combination with fibroscopy at intubation time. Following Mallampati classification anesthesiologists, before surgery, classified the airways as easy or difficult according to specified criteria. Discussion: The anesthesiologist’s prediction changed from difficult grade 3 to difficult grade 4 at the time of operation, this because the patient had showed a severe reduction of the mandibular length with the tongue position of the tongue which overlapped the epiglottis making very difficult laryngeal glottis view at the intubation time. Efficacy of the “Tongue traction maneuver” in combination with a planned fibroscopy is reported. High risks of dispnea in short mandible patients at the extubation time after mandible surgery for tongue and pharyngeal swelling are also underlined. Conclusions: Anesthesiologists can derive useful information from facial appearance and facial skeleton, by panoramic X-rays of the jaws, X-ray cephalograms and CT scan analysis that enhances the prediction of a difficult airway intubation. Particularly mouth opening limitations and mandibular operations planning with post-operative tongue and pharyngeal swelling and consequent airway obstruction at the extubation time, have to be carefully evaluated. In craniofacial surgery importance of some maneuvers like “tongue traction” in short thyromental distance alone or in addition to fibroscopy for limited mouth opening cases and a “double step intubation” for narrow nasal airway’s are reported.