Trachlight™ management of succinylcholine-induced subluxation of the temporomandibular joint: a case report and review of the literature

Abstract

Instability of the TMJ is not uncommon, and has several implications for airway management, highlighting the importance of preoperative screening. Limited mouth opening, due to spontaneous subluxation of the TMJ following succinylcholine-induced muscle relaxation in the absence of airway manipulation, has only twice been reported in the literature. This report highlights how tracheal intubation may be accomplished using the Trachlight, in order to secure the airway prior to reduction of the subluxed joint.

Masseter muscle rigidity: Atypical malignant hyperthermia presentation or isolated event?

“…Surgical cricothyroidotomy has been employed in a case difficult intubation following MMR with success[4] while in another due to suxamethonium-induced TMJ subluxation, a Trachlight™was employed. [13] A LMA was used successfully in this case and the latter’s safety in patients with the difficult airway and without any of its contraindications is well documented. [14]…”

'Jaws of steel' after rocuronium

“…Sporadic case reports have suggested different techniques for airway management after MMR like fibreoptic nasotracheal intubation, retrograde endotracheal intubation, surgical cricothyrotomy and use of Trachlight ® . [ 9 ] Though rare, one must be aware of MMR after using muscle relaxants. In case of any incident of masseteric spasm, the aim should be to maintain adequate oxygenation by any means.…”

Dislocation of the temporomandibular joint following general anesthesia

“…TMJ dislocation that occurs during operations is often unnoticed until patients become aware of pain and swelling. Unrecognized TMJ displacement can lead to chronic pain and restricted joint mobility [ 2 ]. We report here two patients who had TMJ dislocation; one was observed in the post-anesthetic care unit (PACU) and the other in the operation room before transfer to the PACU.…”

“…TMJ dislocation is the dislodgement of the condyle from its normal position in the squamo-temporal portion of the cranial base [ 2 , 3 ]. It could occur spontaneously or by trauma, endotracheal intubation, LMA insert, ENT/dental procedures, endoscopy, yawning, laughing, vomiting, transesophageal echo probe placement, seizure, congenital anomaly and medication [ 4 ].…”

“…At the recovery period, we should be concerned about patients who complain pain around the TMJ area, particularly patients with a history of TMJ disorders and who cannot speak well. If the patient is unconscious or unable to respond, a physical examination by checking the range of motion of the TMJ would help [ 2 , 4 ].…”