Anaesthesia for Reconstruction Surgery Post Mandibulectomy in a Patient with a Predicted Difficult Airway: A Case Report


Reconstruction Surgery
Predicted Difficult Airway


How to Cite

Fagbohun OA, Dennar I, Sope O, Theressa O. Anaesthesia for Reconstruction Surgery Post Mandibulectomy in a Patient with a Predicted Difficult Airway: A Case Report. Integr J Med Sci [Internet]. 2021 Feb. 24 [cited 2024 Jun. 15];8. Available from:


Introduction: Mandibular surgeries, edentulous mandible, use of dentures, and aging all predispose to residual mandibular ridge resorption and thinning. The edentulous state of the mandible makes the tongue occlude the upper airway. All these, contribute to difficulty in managing the airway. An adequate pre-operative review helped classify this index patient as high risk for difficult airway and adequate steps were taken to facilitate optimal airway management.
Case report: We present a 53 years old woman with mandibular deformity, anterior neck mass and inadequate mouth opening who has had a segmental mandibulectomy and a soft tissue closure of reconstruction plate. She was scheduled for mandibular reconstruction.
She was successfully intubated using a size 4.5 Intubating Laryngeal Mask Airway (ILMA) through which a size 6.0 ID classic endotracheal tube was introduced for ventilation. A gum elastic bougie was then inserted through the endotracheal tube, both the ILMA and classic endotracheal tube were withdrawn. An armored tube size 6.5 ID was then rail roaded.
Conclusion: The successful anaesthetic management of this difficult airway patient was facilitated by a thorough pre-anaesthetic plan, concise and skilled anaesthetic management strategy with a well organized team work.


Delvin H, Ferguson MW. Alveolar ridge resorption and mandibular atrophy. A review of the role of local and systemic factors. Br Dent J. 1991; 170: 101-104.

Jasper A. Anaesthetic management of post burn contractures. A recurrent challenge from oilpipeline vandalization in Nigeria: A case report. Cases Journal2009; 2(1):9141.

Klemetti E, Vaino P. Effect of bone mineral density in skeleton and mandible on extraction of teeth and clinical alveolar height. J Prosthet Dent. 1993; 70(1):21-25.

Crawley SM, Dalton AJ. Predicting the difficult airway. BJA Education 2015; 15: 253-257.

Apfelbaum JL, Hagberg CA, Caplan RA, Blitt CD, Connis RT, Nickinovich DG, et al. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology. 2013 Feb;118(2):251-270.

Joffe AM, Hetzel S, Liew EC. A Two-handed jaw-thrust technique is superior to the one-handed “EC-clamp” technique for mask ventilation in the apneic unconscious person. Anesthesiology. 2010; Oct, 113(4):873-9 3181ec6414

Neustin SM, Williams R. An unusual failure of a laryngoscope handle. Can J Anesth/JCan Anesth. 2009; 56: 176.

Parmet JL, Colonna-Romano P, Horrow JC, Miller F, Gonzales J, Rosenberg H. The laryngeal mask airway reliably provides rescue ventilation in cases of unanticipated difficult tracheal intubation along with difficult mask ventilation. Anesth Analg.1998; 87(3): 661-665.

Onyekwulu FA, Nwosu A. Emergency airway management with laryngeal mask airway. Niger J Clin Pract. 2011; 14: 95-97.

Chalam KS, Gupta J. Comparison of intubating laryngeal mask airway and fiber opticbronchoscopy for endotracheal intubation in patients undergoing cervical discectomy. J Anaesthesiol Clin Pharmacol. 2016; 32(4):515-518.

Givol N, Gershtansky Y, Halamish-shani T, Taicher S et al. Perianesthetic dental injuries:analysis of incidence reports. J Clin Anesth. 2004; 16(3):173-176DOI:10.1016/j.jclinane.2003.06.004

Magnin C, Bory EN, Motin J. Tooth injuries during intubation: a new preventive device. Ann Fr Anesth Reani.1991;10(2):171-174.

Newland MC, Ellis SJ, Peters KR, Simonson JA, Durham TM, et al. Dental injury associated with anesthesia: a report of 161, 687 anesthetics given over 14 years. J Clin Anesth. 2007; 19(5): 339-345.

Chen JJ, Susetio L, Chao CC. Oral complications associated with endotracheal general anesthesia. Ma Zui Xue Za Zhi. 1990; 28(2):163-169.

Salman A, Vikas D. Dental trauma due to intubation during general anesthesia: incidence, risk factors and prevention. OHSM 2016; 15:1-5

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Copyright (c) 2021 Fagbohun O et al.


Download data is not yet available.


Metrics Loading ...