Anaesthetic implications of temporomandibular joint disease

Aiello, George; Metcalf, Ian

doi:10.1007/bf03008329

Cited by 64 publications

(39 citation statements)

References 17 publications

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“…Especially patients with vascular-type EDS are at a high risk of bleeding, and unless the procedure is considered absolutely life-saving, several authors have concluded that surgery should be avoided whenever possible in this group of patients [18,29,48,49]. If a procedure can be performed under local anesthesia instead of general anesthesia, this can be considered due to reported risk of lesions of the skin, cavum oris, pharynx, larynx, and risk of cervical atlantoaxial subluxation due to laxity of the cervical ligaments and increased risk of temporomandibular dislocation in connection with endotracheal intubation [50,51]. However, local anesthesia has been reported to have a reduced effect on patients with EDS, and therefore it is recommended to combine several different types of local anesthesia in order to achieve sufficient effect [52,53].…”

Section: Discussionmentioning

confidence: 99%

Gastrointestinal Surgery and Related Complications in Patients with Ehlers-Danlos Syndrome: A Systematic Review

Burcharth

Rosenberg

2012

Dig Surg

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Introduction: Ehlers-Danlos syndrome (EDS) is a rare inherited group of connective tissue diseases characterized by joint hypermobility, skin hyperextensibility and bruising tendency. Common features of patients with EDS include vascular and gastrointestinal perforations. The purpose of this systematic review is to address gastrointestinal diseases and the complications associated with surgical treatment of diseases relating to the gastrointestinal system in patients with EDS. Methods: PubMed search including the Medical Subject Heading (MeSH) terms ‘Ehlers-Danlos Syndrome’ and ‘Gastrointestinal Diseases’, and an Embase search including the Map Term to Subject Heading ‘Ehlers-Danlos Syndrome’ with ‘AND’ function of the keyword ‘Gastrointestinal’. Results: The literature search resulted in inclusion of 53 articles after application of eligibility criteria. The primary results drawn from the literature was that spontaneous ruptures of vessels and spontaneous perforations of the sigmoid colon occur in patients with EDS. Conclusion: Surgery in patients with EDS is associated with a high risk of complications, which is why preoperative indications should be considered. Optimal therapy for these patients includes the awareness that EDS is a systemic disease involving fragility, bleeding and spontaneous perforations from almost all organ systems. Often, a nonsurgical approach can be the best choice for these patients, depending on the condition.

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Section: Discussionmentioning

confidence: 99%

Gastrointestinal Surgery and Related Complications in Patients with Ehlers-Danlos Syndrome: A Systematic Review

Burcharth

Rosenberg

2012

Dig Surg

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“…[5][6][7][8][9][10][11][12][13][14][15][16][17][18] However, since the ease of laryngoscopic tracheal intubation depends on several airway elements, no single measure of the airway can be expected to predict difficult intubation accurately, and studies have confirmed the low predictive ability of some of these measures. 15,[19][20][21][22] To develop more predictive models, several investigators have examined the relationship of multiple airway measures and difficult intubation.…”

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confidence: 99%

Predicting difficult intubation: a multivariable analysis

Karkouti

Rose

Wigglesworth

2000

Can J Anesth/J Can Anesth

162

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730CAN J ANESTH 2000 / 47: 8 / pp [730][731][732][733][734][735][736][737][738][739] Purpose: To develop a clinically useful and valid model for predicting difficult laryngoscopic tracheal intubation in patients with seemingly normal airways by adhering to the principles of multivariable model development.Methods: This was an observational study performed at a tertiary-care teaching hospital. Preoperatively, 444 randomly selected patients requiring tracheal intubation for elective surgery were assessed. In addition, 27 patients in whom tracheal intubation was difficult, but were not assessed preoperatively, were assessed postoperatively. One assessor, blinded to the intubation information, collected the predictor variables. A reliable definition for difficult intubation was used and all attempts were made to eliminate sources of bias. Multivariable modeling was performed using logistic regression and the model was validated using the bootstrapping technique.Results: Of the 461 patients included in the analysis, 38 were classified as difficult to intubate. Multivariable analysis identified three airway tests that were highly significant for predicting difficult tracheal intubation. These were: 1) "mouth opening", 2) "chin protrusion", and 3) "atlanto-occipital extension". Using these tests, a validated, highly reliable and predictive model is produced to determine the probability of difficult intubation for patients. At a selected probability cut-off value, the model is 86.8% sensitive and 96.0% specific. Conclusion:A simple and accurate multivariable model, consisting of three airway tests, is produced for predicting difficult laryngoscopic tracheal intubation. Additional studies will be required to determine the accuracy and feasibility of this model when applied to a large sample of new patients by multiple anesthesiologists.Objectif : Élaborer un modèle valide et utilisable en clinique pour prédire des difficultés d'intubation trachéale laryngoscopique chez des patients qui ont apparemment des voies aériennes normales. Utiliser, pour ce faire, les principes d'élaboration d'un modèle multivariable.Méthode : Il s'est agi d'une observation réalisée dans un hôpital d'enseignement de soins tertiaires. Avant l'opéra-tion, on a évalué 444 patients choisis au hasard qui avaient besoin d'intubation endotrachéale pendant une intervention planifiée. De plus, 27 patients chez qui l'intubation a été difficile n'ont été évalués qu'après l'intervention. Un assistant, qui ne connaissait pas les conditions d'intubation, a enregistré les variables de prédiction. Une défi-nition exacte de l'intubation difficile a été utilisée et on a tenté d'éliminer tout biais possible. Une modélisation à multivariables a été réalisée en utilisant une régression logistique et le modèle a été validé par la technique de l'amorce («bootstrapping»).Résultats : Des 461 patients inclus dans l'analyse, 38 ont été difficiles à intuber. L'analyse à multivariables a reconnu trois épreuves d'intubation comme hautement significatives pour prédire une intu...

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“…This relationship was mainly, but not only, the result of rheumatoid disease. The ability to perform mandibular protrusion depends upon proper function of the temporomandibular joint [44]. The temporomandibular joint and the occipito-atlanto-axial complex are close together on the base of the skull, so that a disease process or malformation may well have implications for both joints.…”

Section: Discussionmentioning

confidence: 99%

Difficult direct laryngoscopy in patients with cervical spine disease

1995

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summary Two hundred and fifty three patients were examined before surgery for cervical spine disease. The grade of glottic visibility was determined at direct laryngoscopy, using the classijication proposed by Cormack and Lehane. The overall prevalence of dificulty (grades 3 and 4) was 20%. Patients with disease that includes the occipito-atlanto-axial complex have a higher prevalence of dificulty than those with disease below the axis vertebra. Occipito-atlanto-axial disease is associated with poor mandibular protrusion. The best single predictor of difficulty was reduced separation of the posterior elements of thejrst and second cervical vertebrae on lateral radiographs. The Mallampati examination was the best single predictor on physical examination. The Mallampati may be an indicator ofpoor cranio-cervical extension. Dificulty was rare inpatients with class A mandibular protrusion, and invariable in patients with class C protrusion.

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Anaesthetic implications of temporomandibular joint disease

Abstract: The purpose of this article is to review the functional anatomy of the temporomandibular joint (TMJ)

Cited by 64 publications

References 17 publications

Gastrointestinal Surgery and Related Complications in Patients with Ehlers-Danlos Syndrome: A Systematic Review

Gastrointestinal Surgery and Related Complications in Patients with Ehlers-Danlos Syndrome: A Systematic Review

Predicting difficult intubation: a multivariable analysis

Difficult direct laryngoscopy in patients with cervical spine disease

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