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Massive ameloblastoma: A case report of difficult fiberoptic intubation

INTRODUCTION: Intubation can sometimes be difficult in patients with lesions in the mouth floor. Ameloblastoma is a frequently encountered tumor of the maxillofacial area. An extensive lesion might occupy the floor of the mouth, prevent displacement of the tongue, limiting the space for inserting a...

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Autores principales: Shindo, Yuki, Toda, Shinichi, Kido, Kanta, Masaki, Eiji
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6019686/
https://www.ncbi.nlm.nih.gov/pubmed/30013771
http://dx.doi.org/10.1016/j.amsu.2018.05.011
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author Shindo, Yuki
Toda, Shinichi
Kido, Kanta
Masaki, Eiji
author_facet Shindo, Yuki
Toda, Shinichi
Kido, Kanta
Masaki, Eiji
author_sort Shindo, Yuki
collection PubMed
description INTRODUCTION: Intubation can sometimes be difficult in patients with lesions in the mouth floor. Ameloblastoma is a frequently encountered tumor of the maxillofacial area. An extensive lesion might occupy the floor of the mouth, prevent displacement of the tongue, limiting the space for inserting a laryngoscope blade and resulting in difficult intubation even with fiberoptic bronchoscopy. CASE PRESENTATION: A 66-year-old man (67 kg; 171 cm) with a mental swelling was diagnosed with ameloblastoma and scheduled for surgical resection. The tumor was extensive, occupying most of the anterior floor of the mouth. We were concerned about impossible direct laryngoscopy because the massive tumor in the floor of the mouth compressed the base of the tongue against the posterior wall of the pharynx, restricting the space for inserting the laryngoscope blade. Therefore, we planned to perform awake nasal fiberoptic intubation to secure the airway. Although the procedure was complicated by the massive tumor, successful intubation was achieved by hand-assisted alteration of the direction of the endotracheal tube (ETT) under direct laryngoscopy. DISCUSSION: Awake fiberoptic intubation was complicated by the tumor protrusion to deviate the ETT. Discovering of the ETT deviation by the insufficient blade insertion facilitated visualizing the vocal cords with the fiberoptic scope. CONCLUSION: Identification of ETT deviation even with insufficient blade insertion and hand-assisted alteration of the direction of the ETT might raise the chances of successful fiberoptic intubation. The anesthesiologist should be aware of the likelihood of failed fiberoptic intubation and plan for alternative approaches to secure the airway.
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spelling pubmed-60196862018-07-16 Massive ameloblastoma: A case report of difficult fiberoptic intubation Shindo, Yuki Toda, Shinichi Kido, Kanta Masaki, Eiji Ann Med Surg (Lond) Case Report INTRODUCTION: Intubation can sometimes be difficult in patients with lesions in the mouth floor. Ameloblastoma is a frequently encountered tumor of the maxillofacial area. An extensive lesion might occupy the floor of the mouth, prevent displacement of the tongue, limiting the space for inserting a laryngoscope blade and resulting in difficult intubation even with fiberoptic bronchoscopy. CASE PRESENTATION: A 66-year-old man (67 kg; 171 cm) with a mental swelling was diagnosed with ameloblastoma and scheduled for surgical resection. The tumor was extensive, occupying most of the anterior floor of the mouth. We were concerned about impossible direct laryngoscopy because the massive tumor in the floor of the mouth compressed the base of the tongue against the posterior wall of the pharynx, restricting the space for inserting the laryngoscope blade. Therefore, we planned to perform awake nasal fiberoptic intubation to secure the airway. Although the procedure was complicated by the massive tumor, successful intubation was achieved by hand-assisted alteration of the direction of the endotracheal tube (ETT) under direct laryngoscopy. DISCUSSION: Awake fiberoptic intubation was complicated by the tumor protrusion to deviate the ETT. Discovering of the ETT deviation by the insufficient blade insertion facilitated visualizing the vocal cords with the fiberoptic scope. CONCLUSION: Identification of ETT deviation even with insufficient blade insertion and hand-assisted alteration of the direction of the ETT might raise the chances of successful fiberoptic intubation. The anesthesiologist should be aware of the likelihood of failed fiberoptic intubation and plan for alternative approaches to secure the airway. Elsevier 2018-06-19 /pmc/articles/PMC6019686/ /pubmed/30013771 http://dx.doi.org/10.1016/j.amsu.2018.05.011 Text en © 2018 The Author(s) http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Case Report
Shindo, Yuki
Toda, Shinichi
Kido, Kanta
Masaki, Eiji
Massive ameloblastoma: A case report of difficult fiberoptic intubation
title Massive ameloblastoma: A case report of difficult fiberoptic intubation
title_full Massive ameloblastoma: A case report of difficult fiberoptic intubation
title_fullStr Massive ameloblastoma: A case report of difficult fiberoptic intubation
title_full_unstemmed Massive ameloblastoma: A case report of difficult fiberoptic intubation
title_short Massive ameloblastoma: A case report of difficult fiberoptic intubation
title_sort massive ameloblastoma: a case report of difficult fiberoptic intubation
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6019686/
https://www.ncbi.nlm.nih.gov/pubmed/30013771
http://dx.doi.org/10.1016/j.amsu.2018.05.011
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