Difficulties with airway management are often caused by anatomic abnormalities due to previous oral surgery. We performed general anesthesia for a patient who had undergone several operations such as hemisection of the mandible and reconstructive surgery with a deltopectoralis flap, resulting in severe maxillofacial deformation. This made it impossible to ventilate with a face mask and to intubate in the normal way. An attempt at oral awake intubation using fiberoptic bronchoscopy was unsuccessful because of severe anatomical abnormality of the neck. We therefore decided to perform retrograde intubation and selected the cuffed oropharyngeal airway (COPA) for airway management. We inserted the COPA, not through the patient's mouth but through the abnormal oropharyngeal space. Retrograde nasal intubation was accomplished with controlled ventilation through the COPA, which proved to be very useful for this difficult airway management during tracheal intubation even though the method was unusual.Abstract
A: The cuffed oropharyngeal airway (COPA). B: A diagram of the COPA in the usual anatomical position.
The patient had a large defect in the anterior part of his neck. The back of the pharynx can be seen through the defect and the mandible was partially exposed. A: Frontal view. B: Lateral view.
A: The cuffed oropharyngeal airway was inserted through the defect in the patient's neck. A guide wire was advanced through the Tuohy needle into the nasal airway. B: The nasal endotracheal tube in proper position following retrograde guide wire–assisted fiberoptic intubation.
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