[Case of pseudoankylosis of the mandible after craniotomy].

Craniotomy sometimes causes pseudoankylosis of the mandible, i.e., limited mouth opening, leading to a difficult airway. We describe a case of difficult airway due to pseudoankylosis of the mandible after craniotomy, in which orotracheal intubation was successfully performed with an AirWay Scope (AWS). A 60-year-old woman was scheduled for clipping of an unruptured cerebral aneurysm. She had undergone emergency clipping of a ruptured cerebral aneurysm under frontotemporal craniotomy on the other side three weeks previously. In the previous anesthesia, she had presented normal mouth opening, and orotracheal intubation had been easily performed. Preoperative examination for the second surgery, however, revealed that she had a limited mouth opening with 1.8 cm of interincisor distance, resulting in a class 4 Mallampati view. A difficult airway was anticipated. In order to avoid the risk of hypertension caused by sedated-awake fiberoptic intubation, we planned orotracheal intubation under general anesthesia with AWS. After careful induction with fentanyl and propofol, the blade was inserted smoothly. Her glottic opening was easily visualized, and her trachea was intubated without any difficulty or any distinct hemodynamic disturbance. Careful assessment of the interincisor distance is essential in patients who have previously undergone craniotomy.