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* From the Department of Anesthesiology and Pain Medicine, and the
Division of Critical Care Medicine, University of Alberta Hospital, Edmonton, Alberta, Canada.
Address correspondence to: Dr. Derek R. Townsend, Intensivist and Anesthesiologist, Division of Critical Care Medicine, 3C1.12 8440 – 112 Street, University of Alberta Hospital, Edmonton, Alberta T6G 2B7, Canada. Phone: 780-407-8822; E-mail: drt1{at}ualberta.ca
Purpose: We present a case of spontaneous subluxation of the Temporo-mandibular joint (TMJ) induced by succinylcholine, to compare our experience with previous cases reported in the literature, and to review the pathophysiology, preoperative screening, and intraoperative management of TMJ instability.
Clinical features: A 39-yr-old female with primary hyperparathyroidism and a normal airway examination presented for elective parathyroidectomy. Following induction of anesthesia and the administration of succinylcholine prior to jaw manipulation, her mouth could not be opened, and we suspected spontaneous subluxation of the TMJ. We secured the airway with the use of a TrachlightTM and, subsequently, reduced the joint. Postoperatively, a history of mild TMJ-related symptoms was elicited.
Conclusion: Instability of the TMJ is not uncommon, and has several implications for airway management, highlighting the importance of preoperative screening. Limited mouth opening, due to spontaneous subluxation of the TMJ following succinylcholine-induced muscle relaxation in the absence of airway manipulation, has only twice been reported in the literature. This report highlights how tracheal intubation may be accomplished using the TrachlightTM, in order to secure the airway prior to reduction of the subluxed joint.
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