Flexible fiberoptic laryngoscope guided intubation in difficult oral intubation: an airway management challenge in dental abscess induced trismus

ìntroductìon: Odontogenic abscesses with thè involvement offacial or cervical spaces can be life-threatening and often have tobe drained under generai anaesthesia. Trismus and swelling can moke intubation with a Macintosh laryngoscope difficult or evenimpossible. However, several indirect laryngoscopes and procedures are available to facilitate trachea! intubation when conventionaldirect laryngoscopy hasfailed but thè success and safety ofthese techniques inpatients with a complicated airway management havenoi yet been established.Methods: We retrospectively compar ed two different approaches far trachea! intubation in 100 patients with severe cervicofacialdentai abscess induced trismus: Nasotracheal intubation with flexible fiberoptic laryngoscope and orotracheal intubation with thè aidofa conventional Macintosh laryngoscope. Allpatients were scheduledfor surgical incision and drainage ofthe abscess under generaianaesthesia. Depending onpre-operative airway evaluation, patients were allocated to expected easy or difficult intubation groups, onthè basis of mouth opening, modified Mallampati score, history of difficult intubation, obvious swelling or reduced oropharyngealspace. Success rate, visualization ofthe glottis and intubation duration were evaluated.Results: Ali thè expected easy intubations were successfully performed with thè respective technique. In thè expected difficultintubation group, thè success rate was higher (25/27 vs 6/23;p < 0.01), thè view at thè glottis was better ( p < 0.01) and intubationduration was shorter ( p < 0.01) with thè flexible fiberoptic laryngoscope compared with thè Macintosh, respectively.Conclusion: In patients with odontogenic abscesses and difficult trachea! intubations, thè use of a flexible fiberoptic laryngo-scope is more effective than thè Macintosh laryngoscope