Evaluation of Temporomandibular Joint by Anesthetists in Florida When Conducting Orotracheal Intubation—A Pilot Study

Abstract

Background: Orotracheal intubation has been considered a risk factor for the development or exacerbation of disorders related to the temporomandibular joint (TMJ). The objective of this pilot study was to evaluate TMJ assessment performed by anesthetists in Florida when conducting orotracheal intubation. Methods: An online questionnaire was created using Qualtrics. The survey included 22 questions related to demographics, TMJ related to anesthesia procedures, and education/awareness regarding TMJ related to intubation. Descriptive statistics and cross-tabulation analysis were performed. Results: One hundred and eight providers participated (mean 46 years-old ± 12; 59% female). About 50% reported to always evaluate TMJ prior non-emergency intubation. Of those, 56% used an alternative intubation technique based on the TMJ status and 60% never/rarely evaluated TMJ post-intubation. Twenty-five percent reported they did not know of possible intubation effects on TMJ and 47% reported that they did not receive adequate information/education on TMJ management related to intubation in school. After participation, 81% reported to be more aware of the importance of evaluating TMJ. Conclusions: Only half of the providers who frequently performed intubation in Florida evaluated TMJ prior to intubation. This survey increased the awareness regarding the importance of evaluating TMJ when conducting intubation. This may contribute to reducing TMJ issues associated with non-emergency intubations.

What factors predict craniomandibular disorders in severe COVID-19 survivors after prolonged intubation?

“…From these findings, it can thus be assumed that early tracheostomy suits COVID-19 MVPs aged ≥ 70 years only (i.e. mortality risks appear unchanged), while PIs in younger patients may be tolerated for 14-28 days [18] (in spite of higher likelihood of developing CMDs [2] , [3] , [4] , [5] , [6] ).…”

“…prolonged intubation (PI), further intensifies the damage. Loss of muscle tone due to anesthetics can increase joint mobilization [2] , [3] , [4] , [5] . In a prospective study (n = 40), laryngoscopic tracheal visualization caused massive (pathologic) TMJ distraction from its physiological position/movement, and one patient (or 2.5%) was reported to have tear of the lateral ligament of the TMJ [5] .…”

“…Another prospective study (n = 200) revealed significant reduced mouth opening within the first post-OTI week in 45 patients (or 22.5%) [6] . Albeit controversial, OTI especially PI is recognized as one risk factor for development and/or exacerbation of CMDs with facial pain [2] , [3] , [4] , [5] , [6] .…”

Diagnosis and management of temporomandibular joint dysfunction before surgery: a case report

“…Preoperative evaluation can reduce problems related to temporomandibular disorders. 8 If a dentist had been consulted prior to surgery and trismus was managed/prevented, patient troubles may have been prevented. If a patient can open the mouth before the operation, anaesthesia could be performed more safely than awake nasotracheal intubation and tracheostomy.…”

Does dental rehabilitation under general anaesthetic contribute to the development of temporomandibular disorders in children and adolescents? A scoping review

“…38 Jaw thrust and direct laryngoscopy manoeuvres are routinely done on anaesthetised patients, where the TMJ has lost some of the protection afforded by the tone of surrounding muscles. 39 In addition, Gadotti et al 40 feel that this loss of muscle tone due to the unconsciousness and muscular relaxation can predispose to greater joint mobilisation and therefore pose a risk of developing future TMD symptoms.…”