Journal of Anaesthesia & Critical Care Case Reports

Vol 8 | Issue 2 | May-August 2022 | Page: 16-18 | Swati Bharti, Ruchi Kapoor, Akanksha Rathore, Sujata Chaudhary

DOI: 10.13107/jaccr.2022.v08i02.201

Author: Swati Bharti [1], Ruchi Kapoor [1], Akanksha Rathore [1], Sujata Chaudhary [1]

[1] Department of Anaesthesiology, Critical Care and Pain Medicine, University College of Medical Sciences and Guru Teg Bahadur Hospital, Shahdara, Delhi, India.

Address of Correspondence
Dr. Swati Bharti
Department of Anaesthesiology, Critical Care and Pain Medicine, University College of Medical Sciences and Guru Teg Bahadur Hospital, Shahdara, Delhi, India.
E-mail: swatibharti2012@gmail.com

Abstract

Introduction: Presence of an intraoral swelling may pose difficulty in laryngoscopy, glottic visualisation and endotracheal intubation using the conventional Mcintosh laryngoscopy. Not only does the mass anatomically hampers the laryngoscopy but also there is risk of trauma to the mass which may bleed and create further difficulty in securing the airway.
Case presentation: An 18-year-old boy presented to us for excision of a mass arising from hard palate since 1½ years. CECT PNS was suggestive of large well-defined lytic expansile area seen in upper alveolus and adjacent hard palate extending into the anterior part of nasal cavity abutting bilateral inferior turbinate and obliterating anterior part of nasal cavity thus a contraindication for nasal intubation. On airway examination, mouth opening was adequate with MPC 1, loose upper incisors, 3×3 cm swelling on hard palate and decreased nasal patency. As the surgeon had to operate in the midline, therefore a plan for retromolar intubation was made to secure the airway using paraglossal approach for direct laryngoscopy with a Millers blade keeping in mind that endotracheal tube shouldn’t interfere in the operative field.
Conclusion: Retromolar intubation can be used successfully for securing airway for surgical procedures in oral cavity when nasotracheal intubation is not possible, and surgical access to airway is best avoided.
Keywords: Retromolar tracheal intubation, Midline hard palate cyst, Airway management

References

1. Swain BP, Nag DS, Samaddar DP, Swain A, Srividhya, Panigrahi B, et al. Does miller straight blade and paraglossal technique provide better laryngoscopy than traditional macintosh blade standard technique – A comparative study? Middle East Journal of Anesthesiology. 2017;24(2):111-8.
2. Jindal P, Khurana G, Gupta D, Chander U. Can Paraglossal Approach be an Effective Alternative to the Conventional Laryngoscopy in Routine Anesthesia Practice- A Comparative Study. J Anesth Clin Res. 2014, 5 :406. doi:10.4172/2155-6148.1000406.
3. Nguyen LT, Thakar SD, Truong AT, Truong DT. Orotracheal Intubation Using the Retromolar Space: A Reliable Alternative Intubation Approach to Prevent Dental Injury. Case Rep Anesthesiol. 2016;2016:3529415.
4. Lee SS, Huang SH, Wu SH, Sun IF, Chu KS, Lai CS, et al. A review of intraoperative airway management for midface facial bone fracture patients. Ann Plast Surg. 2009;63(2):162-6.
5. Dorsch JA, Dorsch SE. Laryngoscopes. In: Dorsch JA, Dorsch SE (Eds). Understanding Anesthesia Equipment, 5th Edition. Philadelphia: Lippincott Williams and Wilkins; 2007.
6. Agrawal S, Asthana V, Meher R, Singh DK. Paraglossal Straight Blade Intubation Technique- an Old Technique Revisited in Difficult Intubations: A Series of 5 Cases. Indian J. Anaesth. 2008;52(3):317-20.
7. Malhotra N. Retromolar intubation: a technical note. Indian J. Anaesth. 2005;49(6):467-8.
8. Dutta A, Kumar V, Saha SS, Sood J, Khazanchi RK. Retromolar tracheal tube positioning for patients undergoing faciomaxillary surgery. Can J Anaesth. 2005;52(3):341.

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