title: Unanticipated cannot intubate situation due to difficult mouth opening.
abstract: We report a case of unanticipated difficult endotracheal intubation secondary to an abrupt onset of difficulty in opening the mouth in an anesthetized adult. A female aged 76 years with American Society of Anesthetists risk Class IV E with an apparently normal preoperative temporomandibular joint was scheduled for emergency laparotomy. Following rapid sequence induction, and muscle relaxation with rocuronium, the anesthesiologist noticed lock-jaw when intubation was attempted. She was ventilated with nasopharyngeal airway, but was progressively desaturating. An emergency tracheostomy was performed. Unfortunately, she sustained cardiac arrest and could not be revived. The complication of the lock-jaw is a nightmare to airway management, especially in an unprepared situation.
authors: Department of Anesthesiology and Intensive Care, Nizam's Institute of Medical Sciences, Hyderabad, Andhra Pradesh, India.
authors: Karunakara Rao
authors: KR
authors: Akasapu
authors: Department of Anesthesiology and Intensive Care, Nizam's Institute of Medical Sciences, Hyderabad, Andhra Pradesh, India.
authors: Sridhar
authors: S
authors: Wuduru
authors: Department of Anesthesiology and Intensive Care, Nizam's Institute of Medical Sciences, Hyderabad, Andhra Pradesh, India.
authors: Narmada
authors: N
authors: Padhy
authors: Department of Anesthesiology and Intensive Care, Nizam's Institute of Medical Sciences, Hyderabad, Andhra Pradesh, India.
authors: Padmaja
authors: P
authors: Durga
keywords: Anterior displacement; difficult intubation; lock-jaw; restricted mouth opening; temporomandibular joint