Difficult airway management: burning no bridges

Abstract

Ameloblastoma is a benign tumor that arises from odontogenic epithelium. It may present a challenge to anaesthetists as it can distort the facial contours and can make bag-mask ventilation difficult. We present a first case of ameloblastoma in our hospital where a 38year-old female was scheduled for a right mandibulectomy and reconstruction of the mandible with a custom-made titanium implant. Awake fiberoptic intubation was planned as a first choice for induction of anaesthesia as any other technique may have led to serious airway complications. We believe that airway management in difficult airway cases should always be based on the principle of "burning no bridges".

2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway

“…224–227,300–303 Case reports also observed successful intubation with flexible intubation scopes (Category B4-B evidence ). 304–356…”

Massive Ameloblastoma Requiring Awake Nasal Fiberoptic Intubation

“…Given its success rate, awake fiberoptic intubation is the gold standard technique for difficult intubation in patients with massive ameloblastoma with intraoral involvement [ 2 ]. Successful awake fiberoptic intubation in cases of massive ameloblastomas has been reported in the literature with the additional use of finger-guided intubations and use of bowed type of Magill forceps to manipulate the ETT [ 2 , 15 ]. Fiberoptic intubation can be done orally or nasally.…”

“…Fiberoptic intubation can be done orally or nasally. In our case, nasal intubation was performed given the severe mouth opening limitation, strong gag reflex, and the surgical approach [ 15 ]. Nasal intubation risks epistaxis and trauma to nasal turbinates [ 15 ].…”