Controversies in the Management of the Airway in Panfacial Fractures: A Literature Review and Algorithm Proposal.

Panfacial fractures are complex fractures involving multiple regions of the facial skeleton and may require multiple surgeries over a relatively short period. They are often associated with polytrauma and other injuries including neurotrauma, which require either immediate (ATLS) airway management, prolonged intubation, or repeated intubations for staged surgeries. The choice of airway for the surgical management of these fractures is difficult, as an assessment of the occlusion is required, and the central nasal complex and/or skull base may be involved, making classical orotracheal or nasotracheal intubation problematic.

Blind Nasotracheal Intubation in a Patient With Ankylosing Spondylitis and Severe Cervical Spine Deformities: A Case Report on Challenges and Approaches to Difficult Airway Management.

Airway management in patients with advanced ankylosing spondylitis (AS) presents a unique challenge due to possible cervical spine deformities that restrict neck mobility and affect access to the airway. Traditional airway management strategies, such as direct laryngoscopy and even fiberoptic intubation, are often rendered ineffective due to these anatomical limitations. Furthermore, surgical options like tracheostomy can be infeasible in cases with significant neck deformities, necessitating alternative approaches.

A Reliable Protocol for Fiberoptic Nasal Intubation.

Nasotracheal intubation is crucial for many oral and maxillofacial surgery procedures; however, it presents more challenges than orotracheal intubation and requires a higher level of training, along with various execution options. The routine use of an endotracheal tube (ETT)-first nasal fiberoptic intubation protocol is recommended, specifically in cases where orotracheal intubation is not possible or feasible. In this proposed technique, 137 randomly selected patients underwent fiberoptic nasotracheal intubation for general anesthesia utilizing a strict ETT first protocol.

Does intubation while observing the glottis with a fiberoptic scope reduce postoperative sore throat?

Introduction: In oral maxillofacial surgery, the nasal tracheal tube is mostly used to provide a better surgical field for oral, head and neck operations. Postoperative sore throat and hoarseness are common following tracheal intubation, with an incidence of 11-55%. Then, we previously reported advantage technique of fiberoptic scope to decrease the risk which the tip of the tube is visualized as the tube is advanced which helps avoid impingement of the tube.

Microbiological comparison of the disinfecting efficacy of small and large cotton swabs in nasotracheal intubation: a randomized trial.

Background: Nasotracheal intubation (NTI) is necessary during surgeries requiring clear access to the surgical field and in patients with respiratory issues. This study investigates the pre-NTI nasal disinfection efficacy of different cotton swab sizes, hypothesizing that smaller swabs could minimize bleeding while maintaining disinfection efficacy.

Methods: Patients classified as American Society of Anesthesiologists-physical status (ASA-PS) class 1 or 2 scheduled for general anesthesia with NTI were randomly assigned to either a large cotton swabs (LCS) or fine cotton swabs (FCS) group in this randomized controlled trial (RCT).

Intraoperative Endobronchial Intubation After Successful Submental Intubation.

In complex maxillofacial fractures in which orotracheal and nasotracheal intubation are otherwise contraindicated, alternatives for airway management include tracheostomy and submental intubation (SMI). In this case, SMI was used successfully, although it did result in accidental endobronchial intubation intraoperatively that was quickly recognized and managed appropriately. SMI can be a useful method for securing a patient's airway, but like all surgical approaches, it does carry the potential for complications.

Anaesthesia Management of A Patient with Airway Obstruction Caused by Prosthetic Vascular Graft Invasion into the Tracheal Lumen.

Primary intratracheal masses causing luminal obstruction are relatively rare, posing a challenge for anaesthesiologists in airway management. This case report describes a distinctive airway management approach in a 71-year-old female patient with an aorta-carotid artery bypass graft that significantly obstructed the trachea. The patient presented with worsening shortness of breath, and a thoracic computed tomography scan revealed a 19.

Cuff tear of endotracheal tube induced by a palatal orthodontic device during nasotracheal intubation: a case report.

Orthognathic surgery often requires intraoral orthodontic appliances that are fixed directly to the bone, which can complicate nasotracheal intubation if the devices protrude into the nasal cavity. This case report describes a 19-year-old man scheduled for elective orthognathic surgery who experienced recurrent cuff tears of the endotracheal tube during nasotracheal intubation due to protruding orthodontic screws in the palate. Despite initial attempts at nasotracheal intubation through the left nostril, the cuff of the 7.

A Case of Transient Ventilation Difficulty Caused by the Occlusion of a Nasotracheal Intubation Tube Due to the Weight of the Tongue in a Patient With Morbid Obesity.

In patients with obesity, airway obstruction is more likely to occur because of the effects of gravity on the supine position and compression of the airway caused by the weight of soft tissues. This significantly increases the risk of apnea and hypoxemia. Therefore, careful airway monitoring and securing are essential after anesthesia induction and during postoperative recovery.

A comparison of McGrath video laryngoscope and Macintosh laryngoscope during nasotracheal intubation: A randomised controlled study.

Background: Nasotracheal intubation is challenging for anaesthesiologists in faciomaxillary injuries due to the anticipated difficult airways. The effectiveness of a non-channelled McGrath video laryngoscope was compared with a conventional Macintosh laryngoscope during nasotracheal intubation.

Methods: Sixty American Society of Anaesthesiologists I-II patients aged between 18 and 60 years of both sexes undergoing elective faciomaxillary surgeries from September 2019 to February 2020 were prospectively randomised into two groups (Macintosh laryngoscope Group, McGrath video laryngoscope Group) of 30.

Embolization and sclerotherapy for head and neck arteriovenous malformations with uncontrollable torrential bleeding.

Torrential bleeding is a rare and life-threatening complication of arteriovenous malformations (AVMs). We report a case of head and neck AVMs present with uncontrollable torrential bleeding, which was treated with embolization and sclerotherapy. Then we explored the potential multidisciplinary handling of the procedure for this kind of case.

Traumatic thyrohyoid membrane rupture with hyolaryngeal separation due to strangulation injury.

Background: Cervical injuries due to hanging have a high mortality rate. Survivors may present for care with subtle symptoms that belie potentially life-threatening injuries to vital structures of the neck.

Case Report: We report a case of a 39-year-old male admitted to the Intensive Care Unit following attempted self-strangulation.

Comparison of propofol versus dexmedetomidine sedation for awake C-MAC D-Blade video laryngoscopic nasotracheal intubation in patients with difficult airway: A randomised clinical study.

Background And Aims: Awake intubation is the preferred method for securing difficult airways. We compared intravenous (IV) propofol and dexmedetomidine for C-MAC D-blade-guided anticipated difficult nasotracheal intubation under conscious sedation.

Methods: This randomised study included 60 patients with difficult airway (El-Ganzouri Score 4-9).

Reverse tube direction and epistaxis in left nasotracheal intubation: a randomized controlled trial.

Background: The incidence of epistaxis during nasotracheal intubation via the left nostril is more frequent than that during intubation via the right nostril. This study evaluated the effect of the reverse bevel and tip direction of the nasotracheal tube on the incidence of epistaxis during nasotracheal intubation via the left nostril.

Methods: Patients undergoing right-sided maxillofacial surgery requiring left nasotracheal intubation were randomly allocated to the control (tracheal tube in the conventional direction) or reverse (a 180˚ reverse direction, with the tube bevel facing the nasal septum and the leading edge (i.

The Flexible Rhino-Laryngoscope for Awake Nasotracheal Intubation.

Difficulties or failures in securing the airway still occur and can lead to permanent disabilities and mortality. Patients with head and neck pathologies obstructing airway access are at risk of airway management failure once they lose spontaneous respiration. Awake flexible scope intubation is considered the gold standard for controlling the airway in such patients.

Bilateral TMJ Ankylosis with limited mouth opening in pediatric patients: An anesthetic challenge.

Restricted mouth opening is a challenging airway in pediatric patients with temperomandibular joint (TMJ) ankylosis. The fiber-optic bronchoscopic nasotracheal intubation technique continues to be the gold standard for difficult airway, among the techniques available such as submandibular intubation, retrograde intubation, and tracheostomy. However, awake fiber-optic bronchoscopy (FOB) is difficult to achieve in pediatric patients.