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Moschini V. 1, Rossi D. 1, Derada Troletti G. 2, Rossi R. 1
1 Azienda Ospedaliera, Istituti Clinici di Perfezionamento - Milano, Servizio di Anestesia e Rianimazione;
2 Azienda Ospedaliera, Istituti Clinici di Perfezionamento - Milano, Divisione di Chirurgia Maxillofacciale
Background. Evaluation of difficulties and modalities of tracheal intubation in maxillofacial surgery.
Methods. Design: retrospective study. Setting: maxillofacial operation room. 2152 patients who underwent elective maxillofacial surgery during a five-year time, from 1994 to 1998. Indications and alternative modalities of tracheal intubation throuch fiberoptic bronchoscope in eight patients (0.37%) with preoperatively evaluated difficult intubation due to temporomandibular ankylosis (3 patients), burns sequelae (1 patient), craniofacial congenital malformations (2 patients), unstables fractures of the cervical spine (2 patients), are discussed. Fiberoptic bronchoscope was used through nasotracheal route under topical nasal and laryngeal anaesthesia, combined with appropriate benzoanalgesia, in order to maintain spontaneous breathing. Proper positioning of tracheal tube was directly checked by fiberoptic bronchoscope, through visualization of the tracheal carina.
Results. In seven patients tracheal intubation was easily performed without complications in less than 20 minutes. In the eigth patients the time spent was 35 minutes, due to important nasal bleeding, which caused a change of the nostril.
Conclusion. Among the alternative methods of elective tracheal inntubation, previously evaluated as difficult or impossible using conventional laryngoscopy, the use of fiberoptic bronchoscope seems to be safest and easiest to use, although not the cheapest.