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AMBULATORY ANESTHESIA

Unsuspected Temporomandibular Joint Pathology Leading to a Difficult Endotracheal Intubation

Department of Anesthesiology, The Ohio State University, Columbus, Ohio

Address correspondence to Robert H. Small, MD, Department of Anesthesiology, The Ohio State University, 410 W. 10th Ave., Columbus, OH 43210. Address e-mail to small.12{at}osu.edu The authors will not provide reprints.

A 40-yr-old woman with an unremarkable medical history and no prior surgeries presented for ambulatory surgery. Physical examination revealed normal jaw opening. On induction of general anesthesia, her jaw was found to be locked in a nearly closed position. We discuss anesthetic considerations and the pathology of temporomandibular joint anterior disk dislocation without reduction. A simple maneuver to reduce the dislocation is described.

IMPLICATIONS: The result of failing to secure the airway of a patient undergoing general anesthesia can be catastrophic. It is ominous when there is a condition that makes airway management difficult and that is not easily diagnosed in advance. This report discusses one such condition and describes a technique to overcome the difficulty.

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