Unexpectedly complicated laryngoscopy caused by a massive mandibular tori

Here, we report a case of an unexpectedly complicated laryngoscopy caused by massive mandibular tori. A 64-year-old man with mitral regurgitation and aortic regurgitation was scheduled for a double valve replacement. Thyromental distance and the Mallampati score were used as predictive factors of di...

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Bibliographic Details
Published in:	Masui. The Japanese journal of anesthesiology Vol. 61; no. 8; p. 844
Main Authors:	Suzuki, Sari, Hino, Hirofumi, Ohji, Moriyoshi, Doi, Akiko, Mukumoto, Chisako, Tateda, Takeshi
Format:	Journal Article
Language:	Japanese
Published:	Japan 01-08-2012
Subjects:	Anesthesia Aortic Valve Insufficiency - complications Aortic Valve Insufficiency - surgery Heart Valve Prosthesis Implantation Humans Intubation, Intratracheal - methods Laryngoscopes Laryngoscopy Male Mandible - abnormalities Mandible - pathology Middle Aged Mitral Valve Insufficiency - complications Mitral Valve Insufficiency - surgery Perioperative Care
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Summary:	Here, we report a case of an unexpectedly complicated laryngoscopy caused by massive mandibular tori. A 64-year-old man with mitral regurgitation and aortic regurgitation was scheduled for a double valve replacement. Thyromental distance and the Mallampati score were used as predictive factors of difficult intubation, and both factors were within the normal range. Anesthesia with controlled ventilation was started with fentanyl, propofol and vecuronium. After the attainment of full muscle relaxation, an experienced anesthesiologist performed direct laryngoscopy. It was not possible to intubate the patient under direct laryngoscopy because of massive mandibular tori which had not been detected prior to induction. Following the failure of direct laryngoscopy, a McCoy laryngoscope and a gum elastic bougie were deployed to improve vision. Intubation with a 7.5 mm tube was successful at the third attempt. We hope our experience will serve as a reminder to clinicians that mandibular tori, although benign and without subjective symptoms, could have significant effects upon direct laryngoscopy by compromising the line of vision. Preoperative oral evaluation is critical and aggressive treatment should be considered.
ISSN:	0021-4892