1/82. Hazard: denture clasps embedded in oral tissues--case reports.Three patients presented with their dentures stuck in their mouths due to a retainer clasp becoming embedded in either the anterior fauces or the soft palate. All three dentures were extricated successfully and the resulting puncture wounds were left to heal spontaneously with only antibiotics and analgesics. In all three cases, a sharp pointed molar clasp tip was found to be a common factor. The management and prevention of such cases are presented.- - - - - - - - - - ranking = 1keywords = mouth (Clic here for more details about this article) |
2/82. airway management in ludwig's angina.A 37-year-old 91 kg man presented with features of ludwig's angina. Anaesthesia for incision and drainage of his submandibular abscess was undertaken by two specialist anaesthetists with an otorhinolaryngological surgeon prepared for immediate tracheostomy. After preoxygenation, gas induction with sevoflurane in oxygen was followed by a gush of pus into the oral cavity and laryngospam causing acute upper airway obstruction. This resolved with 25 mg of suxamethonium and an endotracheal tube was passed into the trachea with difficulty. Options for management of the difficult airway in ludwig's angina are discussed.- - - - - - - - - - ranking = 0.52684520751918keywords = oral cavity, cavity (Clic here for more details about this article) |
3/82. Massive postoperative swelling of the tongue: manual decompression and tactile intubation as a life-saving measure.Massive swelling of the tongue due to haemorrhage is a rare but potentially fatal complication secondary to trauma, surgery, tumour invasion or uncontrolled anticoagulant therapy. This article presents a report of bleeding from the left lingual artery secondary to elective excision of a lipoma of the floor of the mouth and subsequent life-threatening upper airway obstruction. In this case, the upper airway obstruction was managed by manual decompression of the tongue and tactile nasal intubation. To our knowledge this case provides the first description of using this method in life-threatening upper airway obstruction caused by massive haemorrhagic swelling of the tongue.- - - - - - - - - - ranking = 1keywords = mouth (Clic here for more details about this article) |
4/82. Pleomorphic adenoma causing acute airway obstruction.A case is reported of a pleomorphic adenoma of the minor salivary glands of the oral cavity presenting with acute airway obstruction. This is the first reported case to our knowledge of a mixed salivary tumour of the upper respiratory tract causing upper airway obstruction and acute respiratory failure. The patient had to be intubated and transferred to the intensive care unit. After an elective tracheostomy was performed, the adenoma was excised from its fibrous capsule. It was found to originate from the soft palate and occupied the parapharyngeal space. A high index of suspicion should be kept in order to diagnose tumours of the parapharyngeal space with unusual presentation. These tumours which are usually benign should be considered in the differential diagnosis from more common infectious or traumatic conditions and surgical morbidity should be minimal.- - - - - - - - - - ranking = 0.52684520751918keywords = oral cavity, cavity (Clic here for more details about this article) |
5/82. Subperiosteal release of the floor of the mouth musculature in two cases of Pierre Robin sequence.Many management approaches have been considered to relieve upper respiratory obstruction in patients with Pierre Robin sequence, but the choice of treatment is determined by the severity of the obstruction. These options include prone positioning, the use of a nasal trumpet, and surgery. One surgical technique is the subperiosteal release of the floor of the mouth musculature. The theory behind this procedure is that this musculature is under tension, and therefore it pushes the tongue upward and backward, resulting in respiratory obstruction. In theory, the release of this musculature from the mandible should alleviate the tension and hence clear the obstruction. In an attempt to objectively evaluate this theory, we performed subperiosteal release surgery on two infants. Our first patient required an emergent tracheostomy on postoperative day 2 because of the onset of surgically induced airway edema. To avoid this complication in the second patient, we performed a tracheostomy at the same time as surgery. Pre- and postoperative magnetic resonance imaging in the second patient revealed only a minimal change in the anatomy of the floor of the mouth musculature. We believe the subperiosteal release of the floor of the mouth musculature requires further evaluation before it can be considered to be effective in the surgical treatment of respiratory obstruction in Pierre Robin sequence.- - - - - - - - - - ranking = 7keywords = mouth (Clic here for more details about this article) |
6/82. Mechanical airway obstruction caused by accidental aspiration of part of a ballpoint pen.The authors present three cases of death in children aged 4, 9, and 10 years, respectively, that were first thought to be caused by herbal or other poisonings but at autopsy were found to be caused by airway obstruction from aspiration of ballpoint pen parts. Aspiration of a foreign body is a leading cause of accidental death in children, but the circumstances in these cases were unique. In the first case, a 4-year-old child died shortly after a visit to a traditional healer. The child's mother blamed him for the death and fatally assaulted him. The second case was a 9-year-old who died at school. Case 3 was a 10-year-old who collapsed while playing with a ballpoint pen in her mouth. In the latter two cases, the relatives alleged poisoning. At autopsy, there was no evidence of trauma, disease, or poisoning in all three cases. Ballpoint pen parts were present in the larynx, carina, and left main bronchus, respectively. Features of "asphyxial" death were present, and included subconjunctival hemorrhages, subendocardial hemorrhages, and congestion of the face and internal organs. These deaths are preventable by education of children, parents, and teachers. Ballpoint pen manufacturers should also modify the design of these pens to improve their safety.- - - - - - - - - - ranking = 1keywords = mouth (Clic here for more details about this article) |
7/82. Early treatment of severe mandibular hypoplasia with distraction mesenchymogenesis and bilateral free fibula flaps.The technique of distraction has revolutionized the treatment of mandibular hypoplasia; however, presently large mandibular defects still require bone grafts. Microvascular grafting is commonly used in adults. Conversely, in pediatric reconstruction, nonvascularized rib grafts remain standard. Unfortunately, resorption of nonvascularized bone remains a major issue, particularly when soft tissue is hypoplastic. This case study represents a combination of techniques in the treatment of severe mandibular deficiency, and introduces the concept of distraction mesenchymogenesis. The patient was a 2 1/2-year-old boy with severe bilateral Pruzansky class III mandibular hypoplasia. He had a permanent open mouth posture, an overjet of 23 mm, and was unable to move the lower mandibular segment. His oropharyngeal airway diameter was 2.2 mm and he was tracheostomy dependent. The patient was treated with distraction of the lower jaw mesenchyme followed by bilateral functional free fibular microvascular flaps containing reinnervated muscle. This created a well-vascularized body, ramus, and condyle bilaterally within an adequate soft-tissue envelope. Postoperatively, the overjet was reduced to 5 mm. The patient can now actively move his mandible. Airway diameter increased to 10 mm, and the patient is able to tolerate intermittent tracheostomy plugging. This innovative combination of techniques allows early intervention, limits graft resorption, and improves airway control.- - - - - - - - - - ranking = 1keywords = mouth (Clic here for more details about this article) |
8/82. A clinical report about an unusual occurrence of post-anesthetic tongue swelling.dentures are routinely removed from the oral cavity before general anesthetic procedures. They are only reinserted much later when the patient returns to the room. This clinical report describes an edentulous patient who developed acute tongue swelling from venous congestion as a result of tongue recovery from general anesthesia. Her complete dentures were used to separate the residual ridges during the recovery period and relieved the congestion. Denture insertion increased the height and volume of the oral cavity, which reduced pressure on the tongue, preventing a cycle of tongue compression, congestion, and swelling. This unusual complication suggests that it may be prudent for the edentulous patient to be accompanied by their dentures in the perioperative period.- - - - - - - - - - ranking = 1.0536904150384keywords = oral cavity, cavity (Clic here for more details about this article) |
9/82. The anaesthetic management of a case of severe upper airways obstruction due to an enlarging subglottic benign polyp.The use of a newly developed aid to jet ventilation of the lungs, a modified Ben-Jet tube (the Hunsaker Monjet tube), is described in a patient with partial upper airway obstruction. This report highlights an unusual use of this device. The Monjet is a fluoroplastic, monitored, self-centring, fine bore tube that can be inserted from the mouth through to the subglottic region. It was originally developed to anaesthetize healthy patients without airway obstruction who were undergoing suspension microlaryngoscopy.- - - - - - - - - - ranking = 1keywords = mouth (Clic here for more details about this article) |
10/82. EXIT procedure in a twin gestation and review of the literature.prenatal diagnosis can show masses of the fetal neck, mouth, and face that can potentially cause respiratory distress at birth. To prevent such an emergency, the EXIT (ex utero intrapartum technique) is performed: it is the intrapartum intubation of the fetus at term while still connected to the placenta. The EXIT procedure was first performed in a case of cervical teratoma. Up to now a total of 34 cases are described, mostly cervical teratomas (13 cases), lymphangiomas (7), epignathus (3); babies' outcome has been successful in 25 of them, with one death related to the procedure. Among the reported cases we are aware of only one where EXIT was performed in a twin gestation, in which the normal twin was delivered first. In our case the normal fetus was posterior to the twin with cervical malformation, requiring us to work on the latter while the former was still in the uterus. After having safely secured the airway in twin A, twin B was prompt delivered with excellent general conditions. Our limited experience enlarges the possibility to perform this prenatal procedure even in "nonstandard" conditions, such as a twin gestation, and may prove useful to those who are going to deal with such issues.- - - - - - - - - - ranking = 1keywords = mouth (Clic here for more details about this article) |
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