Qualitative and quantitative assessment of benefit of fiberoptic intubation over blind nasal intubation in limited mouth opening scenario of maxillofacial surgery. our simplified approach in airway management

Introduction: Maxillofacial surgeries with limited mouth opening, poses an airway challenge to the attending anesthetist during surgery. This study retrospectively reviewed the anaesthesia assessment concepts related to airway evaluation invarious clinical conditions of difficult intubation patients and morbidity of different techniques of nasal intubation and present our approach for airway management in such patients to overcome adverse complications.
Methodology: An 4-year retrospective study of 32 cases treated in our institution in the year of January 2016 to March 2020 was carried out. Data collected included demographic variables and clinical data, predictors of difficult airway, complications, patient comfort and satisfaction during intubation techniques. Descriptive analysis of data was performed for the entire qualitative and quantitative variables of Blind Naso-tracheal Intubation and Fiber optic Intubation. The Mann- Whitney U test was used at 0.05 level and significance to compare the parameters of the study.
Results: Males are more commonly affected than females with a ratio of2:1 with ameanage group of 30 years. The pathological conditions include Temporomandibular ankylosis (25%), Oral submucous fibrosis (18.75%), Bilateral Parasymphysis Fracture (37.5%), Ludwigs angina (3.1%), Carcinoma of Retromolar trigone (3.1%), Massetric space infection (12.5%) reported. The mouth opening was less <2cms in all cases with an average of 5mm interincisor gap. We have managed difficult airway by blind nasal intubation (mean time 16.51±3.07 minutes), compared to fibreoptic intubation with (mean time 8.54±1.36 minutes). Patient satisfaction was excellent with less complications in fibreoptic compared to blind nasal intubation. P value <0.05 and was statistically significant.
Discussion: Fiber optic intubation with deep sedation is still considered as the gold standard for difficult intubation cases. We have highlighted its role in limited mouth opening patients of bilateral Temporomandibular ankylos is with minimal risk. We have established our guidelines or algorithm depending on the expertise in the field and the facility available in our institution. The treatment protocol followed and predictors assessed for difficult airway is applicable to all limited mouth open ingscenarioin maxillofacial surgery to overcome life threatening complications associated with intubation techniques.