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Korean J Crit Care Med > Volume 17(1); 2002 > Article
Korean Journal of Critical Care Medicine 2002;17(1): 34-37.
증례 : 증례 보고 ; 인지되지 못한 측두하악관절 장애로 인한 어려운 기관내 삽관 - 증례 보고 -
단국대학교 의과대학 마취과학교실
Difficult Endotracheal Intubation Due to Unrecognized Dysfunction of Temporomandibular Joint: A case report
Bong Jin Kang
Department of Anesthesiology, College of Medicine, The Dankook University, Cheon-an, Korea. anebjkang@hanmail.net
In association with facial trauma, fracture of mandibular condyle occurs frequently. From that injury, the dysfunction of temporomandibular joint and the following limitation of mouth opening causing difficult intubation can result. So the anesthesiologists should have the capability of recognizing such problems. But in the case of facial trauma, pain and muscle spasm also cause similar but reversible conditions posing difficulty in differential diagnosis. In this case the patient showed some degree of limitation in mouth opening (1 finger breath) at the preoperative evaluation, so the author performed routine induction expecting the occurrence of full mouth opening after muscle relaxation. But the patient's mouth couldn't be opened any further and the exposure of epiglottis was impossible. Now since we have no reliable predictive criteria of irreversible temporomandibular joint dysfunction, awake fiberoptic intubation should be strongly considered in the case of condylar fracture with any limitations in mouth opening.
Key Words: Intubation, Tracheal: difficult; temporomandibular joint
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