Lingual pressures induced by mouthgags

Area of Science:

• Oral and Maxillofacial Surgery
• Anesthesiology
• Surgical Complications

Background:

• Airway obstruction due to tongue edema after intraoral procedures is an uncommon yet critical complication.
• Postoperative lingual edema can lead to acute airway obstruction, necessitating vigilant surgical monitoring.
• The underlying cause of lingual edema is suspected to be tissue ischemia resulting from venous or arterial obstruction.

Purpose of the Study:

• To investigate the relationship between mouthgag pressure and the risk of postoperative lingual edema.
• To determine if typical mouthgag pressures exceed physiological vascular pressures.
• To propose a protocol for safe mouthgag usage to mitigate risks.

Main Methods:

• Pressure measurements were taken during normal mouthgag use and suspension.
• Pressures generated by the mouthgag were compared to typical venous and arterial pressures.
• The study considered the variability of pressure transfer based on patient dentofacial anatomy.

Main Results:

• Mouthgag use during normal operation frequently generated pressures exceeding venous pressure and often arterial pressure.
• Suspension of the mouthgag almost invariably resulted in pressures surpassing arterial pressure.
• The transferability of these pressures to patient vasculature is highly variable.

Conclusions:

• High pressures generated by mouthgags are a likely contributor to postoperative lingual edema.
• Avoiding excessive mouthgag pressures is crucial for minimizing the risk of this complication.
• The U.C. Davis Mouthgag Usage Protocol offers guidance for safer clinical practice.