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Use of a Modified Ovassapian Airway to Increase Mouth Opening for Fiberoptic Orotracheal Intubation in a Patient with Severe Trismus

Truong, Angela MD; Truong, Dam-Thuy MD

doi: 10.1213/ANE.0b013e3182297049
Letters to the Editor: Letters & Announcements
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Department of Anesthesiology and Perioperative Medicine University of Texas M.D. Anderson Cancer Center Houston, Texas atruong@mdanderson.org (A. Truong, D. Truong)

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To the Editor

When the outside diameter of the endotracheal tube is greater than the interincisor distance, oral intubation between the teeth is impossible. We present a novel approach to increase the oral aperture in a patient with severe trismus. A modified Ovassapian airway was used as a wedge to increase mouth opening, enabling fiberoptic oral intubation. Written patient consent was obtained for this submission.

A 67-year-old man with oral carcinoma presenting for mandibulectomy had undergone prior tumor resection and radiotherapy. Osteoradionecrosis caused marked trismus. Because of the recent placement of a drug-eluting stent for coronary artery disease, aspirin and clopidogrel were continued throughout the perioperative period to prevent stent thrombosis. Nasal tracheal intubation was undesirable because of the risk of epistaxis. His interincisor distance was 8 mm and it was impossible to fully insert an Ovassapian airway into the mouth. The airway was modified by cutting out the proximal ring of the intubating channel. It was then possible to insert the airway deeper into the oral cavity and advance as a slanted wedge, slowly increasing mouth opening to 12 mm (Fig. 1) and allowing successful awake fiberoptic orotracheal intubation. By achieving a modest increase in mouth opening, this modified Ovassapian airway enabled successful oral intubation.

Figure 1

Figure 1

Angela Truong, MD

Dam-Thuy Truong, MD

Department of Anesthesiology and Perioperative Medicine

University of Texas M.D. Anderson Cancer Center

Houston, Texas

atruong@mdanderson.org

© 2011 International Anesthesia Research Society