2018 Volume 46 Issue 2 Pages 89-91
We report a case in which a displaced tooth in the palate made the insertion of a laryngoscope difficult during endotracheal intubation.
A 16-year-old patient with Treacher-Collins syndrome was scheduled to undergo general anesthesia for an iliac bone graft to repair a bone defect in the hard palate. General anesthesia was induced by the spontaneous inhalation of oxygen, nitrous oxide and sevoflurane. As the spontaneous respiration was easily suppressed, mask ventilation and the use of a nasopharyngeal airway became necessary because of airway obstruction. While the patient was unconscious, we attempted to insert a video-laryngoscope (AIRWAY SCOPETM ; MIC Medical Corporation, Japan) into the pharyngeal space but failed because a displaced tooth in the hard palate disturbed its insertion. Next, we tried to insert another video-laryngoscope (KINGVISIONTM ; Acoma Medical, Japan), which had a thinner blade than the AIRWAY SCOPETM. The video-laryngoscope was inserted into the oral cavity and the blade was advanced into the pharyngeal space, but the vocal cords could not be visualized. Finally, we attempted to insert a fiberscope through the oral cavity using the KINGVISIONTM video-laryngoscope while elevating the epiglottic vallecula. This method worked well, and we were able to complete the fiber-optic intubation successfully. Two years later, the patient underwent tooth extraction prior to another procedure requiring general anesthesia. At this time, a partial view of the vocal cord was obtained using the KINGVISIONTM video-laryngoscope, and we successfully completed the fiber-optic intubation.
This experience suggests that potential obstacles, such as dislocated teeth, should be removed prior to general anesthesia and highlights the importance of selecting a suitable laryngoscope to maintain the patient’s airway.
