2020 Volume 48 Issue 1 Pages 7-9
Juvenile hyaline fibromatosis (JHF) is a rare autosomal recessive disease characterized by the presence of tissue nodules, joint contractures, and gingival hyperplasia. In the presently reported case, securing the airway and subsequent intubation were difficult because of the presence of oral and airway tumors and contracture of the jaw and cervical vertebrae. We performed anesthetic management for a 21-month-old patient with JHF who required a gingivectomy and the removal of a skin mass. We anticipated that securing the airway and achieving intubation would be difficult because of trismus, limited cervical movement caused by joint contracture, and narrowing of the oral space because of gingival hyperplasia. General anesthesia was induced using sevoflurane, nitrous oxide, and oxygen inhalation. We attempted to intubate the patient under video-laryngoscopic assistance (AIRWAY SCOPE® : AWS-S200NK, PENTAX) with a pediatric blade ; however, intubation was unsuccessful because the enlarged gingiva prevented the insertion of the blade. Therefore, we safely achieved nasotracheal intubation through both nostrils, providing ventilation through one side of the tracheal tube and inserting the video laryngoscope fiber through the other. The induction of general anesthesia in patients with JHF using oral devices and tools to secure the airway might be difficult because of gingival hyperplasia and joint contracture. Our experience from the present case suggests that nasotracheal intubation via both nasal cavities is effective for intubating patients with JHF.