Retrograde Intubation of Paediatric Difficult Airway With TMJ Ankylosis.

Abstract

Temporomandibular joint (TMJ) ankylosis is a restriction of movements caused by intracapsular brous adhesions, brous ankylosis and osseous ankylosis of TMJ joint. Trauma is the main cause of TMJ ankylosis. The anaesthetic management of paediatric patient with TMJ ankylosis is highly difcult task because child will be anxious with limited mouth opening. Hereby we are presenting a case of 12 year old child with TMJ Ankylosis with severely restricted mouth opening(<3mm) posted for release of the ankylotic mass with distraction osteogenesis and interpositional graft placement using dermis fat. Fiberoptic nasotracheal intubation is the gold standard method of securing airway but in resource limited setting we have described a retrograde intubation using COOK retrograde intubation set with the help of guide wire and bougie for securing airway after giving sedation with fentanyl, ketamine, transtracheal block and airway nebulisation with 4% lidocaine. Spontaneous ventilation was maintained till securing the airway. The airway was secured without any complications. Post op mouth opening was adequate, hence patient was extubated uneventfully.