Transorbital endotracheal intubation: a nonstandard approach to a difficult airway

• Published in: Journal of clinical anesthesia Vol. 34; pp. 314 - 317
• Main Authors: Waldron, Nathan H., MD, Stolp, Bryant W., MD, PhD, Ogilvie, Michael P., MD, Powers, David B., MD, DMD, FACS, FRCS (Ed), Shaughnessy, Michael R., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-11-2016; Elsevier Limited
• Subjects: Airway management; Airway Management - methods; Airway management issues; Anesthesia; Anesthesia & Perioperative Care; Bronchoscopy - methods; Critical care issues; Defects; Education in anesthesia; ENT surgery; Fiber Optic Technology; Fiberoptic intubation; Humans; Intubation; Intubation, Intratracheal - methods; Male; Mandible - surgery; Medical personnel; Middle Aged; Mouth; Oral surgery; Orbit; Ostomy; Pain Medicine; Patients; Radiation Injuries - pathology; Radiation Injuries - surgery; Radiation therapy; Sinuses; Trismus - etiology; Trismus - surgery; ENT surgery; Education in anesthesia; Fiberoptic intubation; Airway management issues; Critical care issues; Oral surgery
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/j.jclinane.2016.05.005

Abstract We present the case report of a 49-year-old gentleman with a history of adenoid cystic carcinoma of the left nare status post curative bifrontal craniotomy, left lateral rhinotomy and medial maxillectomy, adjuvant radiotherapy, and orbital exenteration for optic neuropathy, complicated by medial wall dehiscence. His course was also complicated by severe radiation trismus, for which he was scheduled to undergo bilateral mandibular coronoidectomies. Given his limited mouth opening, the surgeon requested a nasal endotracheal tube. Because of concerns of traumatizing his nare, we utilized a flexible fiberoptic bronchoscope to perform asleep transorbital intubation. Airway management in patients with severe trismus may require ingenuity.