Use of retromolar intubation in paediatric maxillofacial trauma

Abstract

Spinal cord stimulation is a well-established and effective treatment for a variety of chronic, intractable pain syndromes, with 27 000 stimulators being implanted annually in the USA alone. 1 Known complications are equipment failure, pain in the region of hardware implantation, infection, and rarely haematomas and spinal cord injury, which necessitate timely, targeted interventions. 2 The true incidence of these complications, however, is not known, although a retrospective analysis using a manufacturer and user facility device experience (MAUDE) database reports the incidence of epidural haematoma as about 0.19%. 3 Subsequent paraparesis after haematoma can prove devastating to the patient as it may, in fact, leave the patient with permanent residual neurological deficit. 4 In conclusion, lead migration is the likely cause of epidural haematoma, not the needle trauma. In particular, the MRI showed a 'thin spread' epidural haematoma. This may explain the spontaneous resolution of the patient's symptoms, as the haematoma spread along the spine, relieving pressure and preventing compression to any single isolated area.

Retromolar intubation for severe trismus: a less invasive alternative to tracheostomy and submental intubation

“…The retromolar space is bound posteriorly by the ascending ramus of the mandible, superiorly by the maxillary tuberosity and anteriorly by the back molars 4. While there are reports of ‘retromolar intubations,’ most descriptions are actually standard intubations with intraoperative shifting of the endotracheal tube to the retromolar space prior to maxillomandibular fixation 3 5–10. Our report differs from these in that we used the retromolar space to access the oropharynx.…”

Retromolar Intubation in Maxillofacial Trauma Patients

“…1 Retromolar intubation has been accepted as a satisfactory noninvasive alternative technique for maintaining the airway in adults as well as pediatric patients with maxillofacial trauma undergoing maxillomandibular fi xation without obscuring the surgical fi eld or compromising the safety and patency of the airway. [2][3][4][5][6] Retromolar intubation was fi rst described by Martinez et al in complex craniomaxillofacial surgeries in which ostectomy was done at the ascending ramus of mandible to create space for endotracheal tube. 7 In our experience with adults, we have never felt the need to do ostectomy at the anterior border of ramus of mandible for creating space for endotracheal tube.…”