Transorbital endotracheal intubation: a nonstandard approach to a difficult airway.
We present the case report of a 49-year-old gentleman with a history of adenoid cystic carcinoma of the left nare status post curative bifrontal craniotomy, left lateral rhinotomy and medial maxillectomy, adjuvant radiotherapy, and orbital exenteration for optic neuropathy, complicated by medial wall dehiscence. His course was also complicated by severe radiation trismus, for which he was scheduled to undergo bilateral mandibular coronoidectomies. Given his limited mouth opening, the surgeon requested a nasal endotracheal tube. Because of concerns of traumatizing his nare, we utilized a flexible fiberoptic bronchoscope to perform asleep transorbital intubation. Airway management in patients with severe trismus may require ingenuity.
Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA. Electronic address: nathan.waldron@dm.duke.edu.
Nathan H
NH
Waldron
Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA. Electronic address: bret.stolp@dm.duke.edu.
Bryant W
BW
Stolp
Department of Surgery, Duke University Medical Center, Durham, NC, USA. Electronic address: michael.ogilvie@dm.duke.edu.
Michael P
MP
Ogilvie
Department of Surgery, Duke University Medical Center, Durham, NC, USA. Electronic address: david.powers@dm.duke.edu.
David B
DB
Powers
Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA. Electronic address: michael.r.shaughnessy@dm.duke.edu.
Michael R
MR
Shaughnessy
D058109:Airway Management / Q000379:methods*; D001999:Bronchoscopy / Q000379:methods*; D005336:Fiber Optic Technology; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D008297:Male; D008334:Mandible / Q000601:surgery; D008875:Middle Aged; D009915:Orbit; D011832:Radiation Injuries / Q000473:pathology / Q000601:surgery; D014313:Trismus / Q000209:etiology / Q000601:surgery*
Airway management issues; Critical care issues; ENT surgery; Education in anesthesia; Fiberoptic intubation; Oral surgery