General Management of a Patient with Severe Motor and Intellectual Disabilities during Dental Treatment after Surgical Closure of the Tracheoinnominate Artery

Abstract

To alleviate increased muscle tone during dental treatment, sedation with nitrous oxide inhalation was performed successfully in a patient with severe motor and intellectual disabilities who underwent surgical closure of the tracheoinnominate artery. The patient was a 35-year-old man who underwent laryngotracheal separation surgery. He had previously received periodic dental checkups and oral cleaning without sedation. This time, the patient received sedation with nitrous oxide inhalation because of an increase in muscle tone during dental treatment. Nitrous oxide gas was applied to the patient through the tube connected to the tracheotomy hole. Appropriate sedation was then achieved and the increase in muscle tone was alleviated, which enabled dental treatment. Sedation with nitrous oxide inhalation can be easily used in patients who have undergone laryngotracheal separation surgery, although precautions should be taken for possible respiratory depression during the procedure. Dental treatment in patients who have undergone surgical closure of the tracheoinnominate artery should be performed with close monitoring for changes in the patient’s head position, excessive load on the neck, and vibration of the tracheal cannula.