Perianesthetic Dental Injuries: Frequency, Outcomes, and Risk Factors

Warner, Mary E.; Benenfeld, Steven M.; Warner, Mark A.; Schroeder, Darrell R.; Maxson, Pamela M.

doi:10.1097/00132586-200002000-00039

Cited by 59 publications

(107 citation statements)

References 0 publications

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“…Dental injury during laryngoscopy is one of the most common complaints against anesthesiologists. 44,45 These types of injuries are often due to pressure on the maxillary incisors, which anesthesiologists sometimes use as a fulcrum for the laryngoscope while attempting to visualize the larynx. Laryngoscopy may also cause inadvertent soft tissue injury to the lips, buccal mucosa, floor of mouth, palate, and tongue.…”

Section: Injury By Anatomic Sitementioning

confidence: 99%

Complications of Airway ManagementDiscussion

Pacheco-Lopez¹,

Berkow

Hillel³

et al. 2014

Respir Care

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Although endotracheal intubation is commonly performed in the hospital setting, it is not without risk. In this article, we review the impact of endotracheal intubation on airway injury by describing the acute and long-term sequelae of each of the most commonly injured anatomic sites along the respiratory tract, including the nasal cavity, oral cavity, oropharynx, larynx, and trachea. Injuries covered include nasoseptal injury, tongue injury, dental injury, mucosal lacerations, vocal cord immobility, and laryngotracheal stenosis, as well as tracheomalacia, tracheoinnominate, and tracheoesophageal fistulas. We discuss the proposed mechanisms of tissue damage that relate to each and present their most common clinical manifestations, along with their respective diagnostic and management options. This article also includes a review of complications of airway management pertaining to video laryngoscopy and supraglottic airway devices. Finally, potential strategies to prevent intubation-associated injuries are outlined.

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Section: Injury By Anatomic Sitementioning

confidence: 99%

Complications of Airway ManagementDiscussion

Pacheco-Lopez¹,

Berkow

Hillel³

et al. 2014

Respir Care

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“…4,5 This is consistent with observations that difficult intubation predicts dental trauma. 2 Thus, the measurements might be used to predict patients at increased risk of dental trauma, assuming that tooth contact and injury frequencies are related. However, we have no direct data concerning The number of cases are given in parentheses.…”

Section: Me Et Th Ho Od Ds Smentioning

confidence: 99%

“…1,2 It is more likely in cases with difficult tracheal intubation, 2 possibly because anesthesiologists may use the upper teeth as a fulcrum when they cannot obtain a satisfactory view of the glottis. Thus, preoperative factors that predict difficult intubation might also predict the risk of dental trauma.…”

mentioning

confidence: 99%

The callander laryngoscope blade modification is associated with a decreased risk of dental contact

Lee

Choi

Lee

et al. 2004

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : Dental damage may occur with laryngoscopy. The purpose of this study was twofold: to determine whether preoperative examination could predict the risk of contacting the teeth with the laryngoscope and to evaluate the effectiveness of a modified Macintosh blade on reducing dental contact.M Me et th ho od ds s: : Four hundred and eighty-three patients scheduled for elective surgery requiring general anesthesia with endotracheal tube placement were studied prospectively. Features that might predict difficult intubation were assessed preoperatively. Laryngoscopy was performed twice on each patient, once with a regular Macintosh 3 blade and once with a blade in which the flange was partially removed (Callander modification). The distance between the flange of the blade and the upper incisors at glottic exposure was measured. We calculated correlations between individual airway characteristics and the chance of hitting the upper teeth with the regular Macintosh 3 blade and compared the frequencies of contacting the teeth between the two blades.R Re es su ul lt ts s: : The chance of hitting the upper teeth when using the regular Macintosh 3 blade increased significantly with non-parametric scores for Mallampati classification, mandibular subluxation, head and neck movement, interincisor gap, and condition of the upper teeth. (P < 0.01) The frequency of direct contact varied significantly between the two blades: 20.3% vs 4.1% for Macintosh 3 and modified blades, respectively (P < 0.05). Laryngeal views were improved with the modified blade.C Co on nc cl lu us si io on n: : Airway characteristics correlate with the risk of hitting the upper teeth during laryngoscopy. The modified Macintosh blade reduces the risk of contacting the teeth. Objectif

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“…62 -68 It is also the adverse event responsible for the greatest number of malpractice claims against anesthesiologists. 63,69 In the perioperative period, the majority of dental injuries (50%-75%) occur during tracheal intubation. 63,64,69 -72 When a satisfactory view of the glottis is difficult to obtain during laryngoscopy, the patient's maxillary anterior teeth are sometimes used as a fulcrum by the laryngoscope blade, which can lead to a dental injury.…”

Section: Perioperative Dental Damagementioning

confidence: 99%