Difficult retrograde endotracheal intubation: the utility of a pharyngeal loop

Direct laryngoscopy and tracheal intubation remains the technique of choice to achieve control of the airway. Alternative or additional techniques of airway control are required whenever an airway is deemed difficult because of anatomical and/or technical reasons. The retrograde intubation technique is an important option for gaining airway access from below the vocal cords in such situations (1). We report successful management and the problems encountered while gaining the upper airway by the retrograde catheter method in a patient having bilateral fibrous ankylosis of the temporomandibular joint (TMJ).

A 30-yr-old woman presented for redo-release of bilateral temporomandibular joint ankylosis under general anesthesia. During the previous anesthetic for primary release of ankylosis, tracheostomy was done, as conventional blind nasotracheal and retrograde intubation attempts failed several times. This case report describes the method for overcoming the difficulties of a retrograde intubation procedure in removing the guiding catheter nasally by using a pharyngeal loop assembly.