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The Rigid Tube as an Alternative in Controlling the Problematic Airway

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Difficult laryngoscopy caused by massive mandibular tori.

Yoshihiro Takasugi¹, Mayuka Shiba, Shinji Okamoto

¹Department of Anesthesiology, Kinki University School of Medicine, 377-2 Ohno-higashi, Osaka-sayama, 589-8511, Japan.

Journal of Anesthesia

|May 16, 2009

Summary

Mandibular tori, bony growths on the lower jaw, can cause difficult intubation. This case highlights the importance of identifying these growths to ensure safe airway management during surgery.

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Area of Science:

Anesthesiology
Oral and Maxillofacial Surgery
Airway Management

Background:

Mandibular tori are benign bony exostoses on the lingual aspect of the mandible.
Their potential to obstruct the airway, leading to difficult intubation, is increasingly recognized.

Observation:

A 62-year-old female patient presented with speech difficulties and bilateral mandibular tori.
Preoperative imaging revealed extensive tori occupying the floor of the mouth.
Initial laryngoscopy attempts were unsuccessful, classifying as Cormack and Lehane grade IV.

Findings:

The large mandibular tori significantly impeded laryngoscope insertion and visualization of airway structures.
Successful airway management was achieved via blind nasotracheal intubation.

Implications:

Clinicians should be aware of mandibular tori as a potential cause of difficult airways.
Thorough preoperative oral examination, including assessment for space-occupying lesions and speech disturbances, is crucial.
Early detection and appropriate airway management strategies are vital for patient safety.