title: An evaluation of the retromolar space for oral tracheal tube placement for maxillofacial surgery in children.
abstract: BACKGROUND
  The eruption of the first and second permanent molar teeth may influence the size of the retromolar space. In this study we evaluated the adequacy of the retromolar space for retromolar intubation and any effect of eruption of the first and second permanent molar teeth on this space in children.
  
  
  METHODS
  Children 3-15 yr of age, undergoing surgery other than facial surgery were included for evaluation of the retromolar space. After standard oral tracheal intubation, the endotracheal tube was shifted to the retromolar space and the mandible was slowly closed to achieve centric occlusion. At the same time, any increase in airway resistance or decrease in oxygen saturation was noted. In the second part of the study, the feasibility of retromolar intubation in pediatric patients undergoing maxillofacial surgery with intraoperative maxillomandibular fixation was assessed.
  
  
  RESULTS
  There was enough space for endotracheal tube placement in the retromolar region. The eruption of the first and second permanent molar teeth did not affect intubation. It was possible to achieve centric occlusion in 79 of 80 children with the endotracheal tube positioned in the retromolar space. Retromolar intubation was successfully accomplished in six pediatric patients undergoing maxillomandibular fixation and maxillofacial surgery.
  
  
  CONCLUSIONS
  The retromolar space can be safely used for intubation in children when intraoperative maxillomandibular fixation, and simultaneous access to the nose and oral cavity are needed.
authors.affiliation: Department of Anaesthesia and Intensive Care, Oral Health Sciences Center, Postgraduate Institute of Medical Education and Research, Chandigarh 160 012, India.
authors.forename: Suman
authors.initials: S
authors.lastname: Arora
authors.forename: Vidya
authors.initials: V
authors.lastname: Rattan
authors.forename: Neerja
authors.initials: N
authors.lastname: Bhardwaj
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods / Q000592:standards*; D008297:Male; D008963:Molar / Q000033:anatomy & histology* / Q000502:physiology; D009055:Mouth / Q000033:anatomy & histology / Q000502:physiology; D013515:Surgery, Oral / Q000379:methods / Q000592:standards*; D014078:Tooth Eruption / Q000502:physiology