[Effects of intubation anesthesia on the temporomandibular joint]

Hardly any attention has so far been paid to temporomandibular joint (TMJ) dysfunction after endotracheal intubation. We examined perioperative lesions of the TMJ in 100 patients who underwent operations in areas other than the head and neck. Fifty of these patients were anesthetized with orotracheal intubation; the other 50 were operated under spinal or peridural anesthesia. The orotracheal intubations were carried out with Macintosh laryngoscopes (blatesize 3). Size 32 Kuhn tubes or Magill tubes were used in 25 patients each. Preoperatively and daily for the first 4 postoperative days, we repeated the history and examined the minimal distance between the occlusal edges of upper and lower incisors (SKD), deviations of the mandible during opening and closing movements, and snapping or grinding of the TMJ. We further measured the duration of intubation, technical difficulties, and the number of years of training of the anesthetist. Age, body length, and preoperative findings were compatible in both patient groups. Operating time was 25% longer in the spinal or peridural anesthesia group. Of the 50 patients with orotracheal intubation, 33 demonstrated a reduced ability of maximal oral opening of up to 35% on the 1st postoperative day. Snapping of the TMJ was observed in 80% of the orotracheally intubated patients on the 1st postoperative day, which was 20% above the preoperative value. TMJ grinding showed no significant changes. Two of the 50 intubated patients complained of TMJ pain, another two had occlusal disturbances, and two had a reduced SKD. There were no detectable differences within the group of intubated patients regarding type of tube or experience of the anesthetist.(ABSTRACT TRUNCATED AT 250 WORDS)