Nasotracheal Intubation in a Pediatric Patient with Temporomandibular Joint Ankylosis

Temporomandibular joint (TME) ankylosis is disease that occurs due to the attachment of mandibula to the base of the skull and restricts opening of the mouth and causes problems in air way management. In this report, in a pediatric case in whom unilateral TME ankylosis developed after traffic accident and who had mouth opening of 1cm. and our nasotracheal intubation experience with the help of a videolaryngoscope is presented. A 11 year old girl at the weight of 34kg. had limitation of mouth opening following a traffic accident and Ear Nose Throat (ENT) department diagnosed her with unilateral TME ankylosis and operation was planned. Tiromental distance was 2cm and sternomental distance was 4,5. Patient was evaluated as difficult intubation and intubation with laryngoscope was planned. Mallampati score was 4, and ASA score was 2. Induction was made with propofol without losing spontaneous respiration. Cormac Lehane grade was found to be II and patient was intubated nasotracheally with 5.5. mm tube using videolaryngoscope. Following the surgical procedure lasting three hours, a successful extubation procedure was carried out using sugammadex. In the prediction of difficult airway, short and muscular neck, low set mandibula, protruding maxilla incisiors, movement restriction in temperomandibular joint, longer alveolar mental distance, cercial movement limitation, mouth opening, tiromental distance, mallampati neck movements, prognathia and body weight are used as predictors. Videolaryngoscopes make it possible to image anatomical structures clearly and to carry out laryngoscopy without bringing oral cavity, pharynx and larynx planes to the same level and to perform endotracheal intubation. In children with temporomandibular joint ankylosis, videolaryngoscope is a safe method in providing airway with nasotracheal intubation.