title: Anesthetic considerations for masticatory muscle tendon-aponeurosis hyperplasia: a report of 24 cases.
abstract: Masticatory muscle tendon-aponeurosis hyperplasia (MMTAH) is a new disease entity characterized by limited mouth opening due to contracture of the masticatory muscles, resulting from hyperplasia of tendons and aponeuroses. In this case series, we report what methods of airway establishment were conclusively chosen after rapid induction of anesthesia. We had 24 consecutive patients with MMTAH who underwent surgical release of its contracture under general anesthesia. Rapid induction of anesthesia with propofol and rocuronium was chosen for all the cases. In 7 cases, intubation using the Macintosh laryngoscopy was attempted; however, 2 of those cases failed to be intubated on the first attempt. Finally, intubation using the McCoy laryngoscopy or fiber-optic intubation was alternatively used in these 2 cases. In 7 cases, the Trachlight was used. In the remaining 10 cases, fiber-optic intubation was used. Limited mouth opening in patients with MMTAH did not improve with muscular relaxation. "Square mandible" has been reported to be one of the clinical features in this disease; however, half of these 24 patients lacked this characteristic, which might affect a definitive diagnosis of this disease for anesthesiologists. An airway problem in patients with MMTAH should not be underestimated, which means that other intubation methods rather than direct laryngoscopy had better be considered.
authors: Department of Anesthesiology, Nara Medical University, Kashihara, Japan.
authors: Ikumi
authors: I
authors: Yamamoto
authors: Satoki
authors: S
authors: Inoue
authors: Masahiko
authors: M
authors: Kawaguchi
authors: Tetsuji
authors: T
authors: Kawakami
authors: Tadaaki
authors: T
authors: Kirita
authors: Hitoshi
authors: H
authors: Furuya
mesh_terms: D000732:Androstanols / Q000008:administration & dosage; D000766:Anesthesia, Dental / Q000379:methods*; D000768:Anesthesia, General / Q000379:methods*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D003238:Connective Tissue / Q000601:surgery; D003286:Contracture / Q000601:surgery; D005336:Fiber Optic Technology; D006801:Humans; D006965:Hyperplasia; D007442:Intubation, Intratracheal / Q000295:instrumentation* / Q000379:methods*; D007828:Laryngoscopy / Q000009:adverse effects; D008334:Mandible / Q000473:pathology; D008406:Masseter Muscle / Q000473:pathology* / Q000601:surgery; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage; D009666:Nose; D019647:Oral Surgical Procedures / Q000379:methods; D015742:Propofol / Q000008:administration & dosage; D000077123:Rocuronium; D013710:Tendons / Q000473:pathology* / Q000601:surgery
chemical_list: D000732:Androstanols; D018686:Anesthetics, Intravenous; D003473:Neuromuscular Nondepolarizing Agents; D000077123:Rocuronium; D015742:Propofol