Abstract
We report three general anesthetic management cases dislocation of the mandible in two elderly patients with a history of cerebrovascular disease.
Case 1: An 86-year-old woman who complained of postprandial inability to close the mouth. At a general hospital, she was diagnosed as having bilateral dislocation of the mandible, and referred to our hospital. It was impossible to perform reposition by her pain.
Therefore, the procedure was performed under general anesthesia. Nasotracheal intubation was performed after induction with thiopental and vecuronium bromide (V. B.). The procedure required 2 minutes, and extubation was possible about 45 minutes later. During induction and procedure the hypertension were managed using calcium channel blocker (diltiazem).
About 8 months later the patient again experienced bilateral dislocation of the mandible. The same procedure was performed again under general anesthesia at our hospital.
Case 2: An 80-year-old woman who was unable to close the mouth as a result of falling when cerebral hemorrhage occurred.
However, the symptom was neglected as a sequela of the cerebral hemorrhage. After about 3 months, the patient was diagnosed as having bilateral dislocation of the mandible at a dental clinic, and referred to our hospital.
The reposition was performed under general anesthesia. Nasotracheal intubation was performed after induction with fentanyl and lidocaine, followed by thiopental and V. B..
The time required for the procedure was 30 minutes.
When patients have a history of cerebrovascular disease, they are at increased risk of recurrence due to sudden changes in blood pressure during the operation. In elderly patients this is most noticeable. For the cases reported here, the cardiovascular system was managed using a calcium channel blocker in Case 1, fentanyl and lidocaine in Case 2.
