Abstract
Ankylosis may be defined as the fusion of joint surfaces. Temporomandibular joint (TMJ) ankylosis is a condition that may cause chewing, digestion, speech, esthetic and psychological disorders. It is a devastating disorder resulting in inability to open the mouth. As a result of this, General anaesthesia, is very difficult to administer because laryngeal inlet is not directly visualized. Even the blind nasal intubation is difficult because of small mandible and tongue fall following relaxation. There are various techniques to overcome these challenges. At times these techniques fail and tracheostomy has to be done. All the risks associated with difficult intubation, and general anaesthesia can be avoided if the surgery is done under conscious sedation. Conscious sedation, a simple but safe and effective method of anaesthesia is described here, which allows successful temporomandibular joint interpositional gap arthroplasty.
Keywords: Conscious sedation, Temporomandibular joint ankylosis, Temporomandibular joint interpositional gap arthroplasty
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References
- 1.Roychoudhury A., Parkash H., Trikha A. Functional restoration by gap arthrosplasty in temporomandibular joint ankylosis: a report of 50 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999;87(2):166–169. doi: 10.1016/S1079-2104(99)70267-2. [DOI] [PubMed] [Google Scholar]
- 2.Su-Gwan K. Treatment of temporomandibular joint ankylosis with temporalis muscle and fascia flap. Int J Oral Maxillofac Surg. 2001;30(3):189–193. doi: 10.1054/ijom.2001.0047. [DOI] [PubMed] [Google Scholar]
- 3.Chidzonga M.M. Temporomandibular joint ankylosis: review of thirty-two cases. Br J Oral Maxillofac Surg. 1999;37(2):123–126. doi: 10.1054/bjom.1997.0089. [DOI] [PubMed] [Google Scholar]
- 4.Jayan B., Roy Chowdhury S.K., Kharbanda O.P., Atul K. Orthodontics in Intraoral Bilateral Sagittal Mandibular Distraction Osteogenesis. J Dentistry Defence Section. 2007;2.2:4–13. [Google Scholar]
- 5.Colmenero C., Esteban R., Albarino A.R., Colmenero B. Sleep apnoea syndrome associated with maxillofacial abnormalities. J Laryngol Otol. 1991;105(2):94–100. doi: 10.1017/S002221510011504X. [DOI] [PubMed] [Google Scholar]
- 6.El-Sheikh M.M., Medra A.M. Management of unilateral temporomandibular ankylosis associated with facial asymmetry. J Craniomaxillofac Surg. 1997;25(3):109–115. doi: 10.1016/s1010-5182(97)80001-7. [DOI] [PubMed] [Google Scholar]
- 7.Shah F.R., Sharma K.R., Hilloowalla R.N., Karandikar A.D. Anaesthetic considerations of temporomandibular joint ankylosis with obstructive sleep apnoea: A case report. J Indian Soc Pedod Prev Dent. 2002;20(1):16–20. [PubMed] [Google Scholar]
- 8.Masood N., Abdullah S. Facilitated blind nasotracheal intubation in paralysed patients with temporomandibular joint ankylosis. J Coll Physicians Surg Pak. 2005;15(1):4–6. [PubMed] [Google Scholar]
- 9.Weisman H., Weis T.W., Elam J.O., Bethune R.M., Bauer R.O. Use of double nasopharyngeal airways in anaesthesia. Anaesth Analg. 1969;48(3):356–358. doi: 10.1213/00000539-196905000-00010. [DOI] [PubMed] [Google Scholar]
- 10.Biswas B.K., Bhattacharyya P., Joshi S., Tuladhar U.R., Baniwal S. Fluoroscope-aided retrograde placement of guide wire for tracheal intubation in patients with limited mouth opening. Br J Anaesth. 2005;94(1):128–131. doi: 10.1093/bja/aeh297. [DOI] [PubMed] [Google Scholar]
- 11.Arya V.K., Dutta A., Chari P., Sharma R.K. Difficult retrograde endotracheal intubation: The utility of a pharyngeal loop. Anesth Analg. 2002;94(2):470–473. doi: 10.1097/00000539-200202000-00046. [DOI] [PubMed] [Google Scholar]
- 12.Vas L., Sawant P. A review of anaesthetic technique in 15 paediatric patients with temporomandibular joint ankylosis. Paediatr Anaesth. 2001;11(2):237–244. doi: 10.1046/j.1460-9592.2001.00608.x. [DOI] [PubMed] [Google Scholar]
- 13.Rendell-Baker L. From something old something new. Anesthesiology. 2000;92(3):913–918. doi: 10.1097/00000542-200003000-00064. [DOI] [PubMed] [Google Scholar]
- 14.Rehman M.A., Schreiner M.S. Oral and nasotracheal light wand guided intubation after failed fibreoptic bronchoscopy. Pediatr Anesth. 1997;7(4):349–351. doi: 10.1046/j.1460-9592.1997.d01-85.x. [DOI] [PubMed] [Google Scholar]
- 15.Waters D.J. Guided blind endotracheal intubation. Anaesthesia. 1963;18:158–162. doi: 10.1111/j.1365-2044.1963.tb13529.x. [DOI] [PubMed] [Google Scholar]
- 16.Poon Y.K. Case history number 89: A life-threatening complication of cricothyroid membrane puncture. Anesth Analg. 1976;55(2):298–301. doi: 10.1213/00000539-197603000-00037. [DOI] [PubMed] [Google Scholar]
- 17.Schillaci C.R., Iacovoni V.F., Conte R.S. Transtracheal aspiration complicated by fatal endotracheal hemorrhage. N Engl J Med. 1976;295(9):488–490. doi: 10.1056/NEJM197608262950907. [DOI] [PubMed] [Google Scholar]