Takasugi Yoshihiro, Shiba Mayuka, Okamoto Shinji, Hatta Koji, Koga Yoshihisa
Department of Anesthesiology, Kinki University School of Medicine, 377-2 Ohno-higashi, Osaka-sayama, 589-8511, Japan.
J Anesth. 2009;23(2):278-80. doi: 10.1007/s00540-008-0717-0. Epub 2009 May 15.
Mandibular tori, defined as bony protuberances located along the lingual aspect of the mandible, are a possible cause of difficult intubation. We describe a case of mandibular tori that resulted in difficult intubation. A 62-year-old woman who had speech problems was diagnosed with mandibular tori, and was scheduled for surgical resection. On physical assessment, the patient had a class II Mallampati view and bilateral mandibular tori. Preoperative computed tomography images demonstrated that the bilateral mandibular tori arose from the lingual aspects of the second incisor to the first molar regions of the mandibular corpus, and occupied the floor of the mouth. In the operating room, anesthesia was induced with remifentanil and propofol. After complete paralysis was achieved, laryngoscopy was attempted several times with Macintosh blades. The massive tori prevented insertion of the tip of the blade into the oropharynx, and neither the epiglottis nor the arytenoids could be visualized, i.e., Cormack and Lehane grade IV. Blind nasotracheal intubation was successful and the surgery proceeded uneventfully. The anesthesiologist should examine any space-occupying lesion of the oral floor and should be vigilant for speech problems in order to detect mandibular tori that might impede intubation.
下颌隆突是指位于下颌骨舌侧的骨质隆起，是导致插管困难的一个可能原因。我们描述了一例因下颌隆突导致插管困难的病例。一名62岁有言语问题的女性被诊断为下颌隆突，并计划进行手术切除。体格检查时，患者为Mallampati II级视野且双侧有下颌隆突。术前计算机断层扫描图像显示双侧下颌隆突起自下颌体第二切牙至第一磨牙区域的舌侧，并占据口底。在手术室，使用瑞芬太尼和丙泊酚诱导麻醉。达到完全肌松后，多次尝试用麦金托什喉镜镜片进行喉镜检查。巨大的隆突阻碍了镜片尖端插入口咽，会厌和声门均无法看清，即科马克和莱汉内分级为IV级。盲探经鼻气管插管成功，手术顺利进行。麻醉医生应检查口底的任何占位性病变，并应对言语问题保持警惕，以便发现可能妨碍插管的下颌隆突。
