A Retrospective Case Series of Anaesthetic Management of Children with Temporomandibular Joint Ankylosis from a Tertiary Level Referral Paediatric Hospital

Abstract

Children with temporomandibular joint ankylosis (TMJA) have unique anaesthetic needs distinctive to their growing developmental anatomy, physiology and the facial distortion caused by the disease per se.  Anaesthesia for release of TMJA in children can turn to a nightmare for any anaesthesiologist if the risks are unanticipated and the treating team is unprepared. In adults, awake fibreoptic intubation has been the gold standard for difficult airway management. In children, there are no clear guidelines issued for management of difficult airways, especially for TMJA. 

 We performed a retrospective review from 2017-2022 of 14 children who presented for surgical correction of unilateral/bilateral TMJA at a paediatric tertiary referral centre.  Maximal interincisor distance (MID) and COPUR (Colorado Paediatric Airway Score) scores were used to plan airway management in these children.

Unilateral TMJA was seen in 11 children and the rest 3 had bilateral TMJA with MID <1 centimetres. Flexible fibreoptic intubation was used as an aid to facilitate intubation in a total of five children with MID < 1 centimetre. Video laryngoscopy and direct laryngoscopy was suitable to visualize the glottic opening in the remaining children with MID >1 centimetres.  

Post traumatic TMJA is on the rise in developing countries and this case series, provides vital information about decision making and referral process while managing children with TMJA in centres with varying infrastructural resources.