[Cervicofacial cellulitis of dental origin and tracheal intubation].
OBJECTIVE
To evaluate the difficulty of intubation in relation with the localisation and spread of cervico-facial cellulitis of odontogenic origin and to recognize the optimal technique of intubation in such circumstances.


METHODS
Prospective clinical open study.


METHODS
Hundred patients, including 16 children, undergoing surgical drainage of a cervico-facial cellulitis of odontogenic origin under general anesthesia were studied.


METHODS
Difficulty of intubation was evaluated with the following four criteria: active mouth opening in the awake patient, Mallampati's classifying system, presence of trismus, clinical and radiological control of localisation and extension of the cellulitis (mandibular, maxillar or mouth floor). In case of a foreseen difficult intubation, a fibrescope was used in the awake patient. Otherwise the endotracheal tube was inserted after administration of propofol (3 mg.k-1) and alfentanil (10 to 20 micrograms.kg-1). A Cormack's grading was performed during intubation.


RESULTS
Mouth opening depended on the localisation of the cellulitis. Trismus occurred more often with mandibular than maxillary localisations. Trismus and a Mallampati's class > 2 were associated with difficulty in intubation (Cormack's grade > 2), except in maxillary localisations.


CONCLUSIONS
The localisation of cellulitis of odontogenic origin is responsible for the difficulty grade of intubation. Awake fibreoptic intubation should be systematically performed in patients with a floor of the mouth cellulitis to reduce the risk of rupture of the abscess by a laryngoscope blade. As trismus associated with mandibular localisations is not relieved by general anaesthesia, awake fibreoptic endotracheal intubation should be preferred.
D000293:Adolescent; D000328:Adult; D000770:Anesthesia, Endotracheal; D002481:Cellulitis / Q000209:etiology* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D004322:Drainage; D005145:Face; D005336:Fiber Optic Technology; D005491:Focal Infection, Dental / Q000150:complications*; D006801:Humans; D007442:Intubation, Intratracheal; D009333:Neck; D014313:Trismus / Q000209:etiology
Cellulites cervico-faciales d'origine dentaire et intubation trachéale.