Difficult Airway Management In A Patient With A Huge Mandibular Tumour For Excision In A Low Resourse Setting: A Case Report.

Abstract

We report the perioperative management of a 30year old man with a recurrent progressive left jaw swelling of two year duration associated with oro-facial discomfort and significant weight loss. There was associated fever and body aches at presentation. No associated loss of dentition. The mass was non tender, measured about 20X18 centimeters in diameter with area of hard and soft consistency located in the mandible displacing the teeth posteriorly. Difficult mask ventilation and intubation were anticipated because of marked distortion of the mandibular and airway anatomy. All relevant equipment were made available to manage difficult intubation. First intubation was unsuccessful. Successful nasotracheal intubation was achieved after the second attempt with the application of external laryngeal manipulation by an experienced assistant. First surgery was uneventful. Patient came back for reoperation on account of wound infection and dislocated prosthesis (Mandibular plate). Intubation was made difficult during anaesthesia for second surgery because dislocated prosthesis obstructed the view of the larynx. This was quickly dislodged with Magil’s forceps. We concluded that airway management remains central to the successful perioperative care in patients with mandibular tumours. Careful preparation and good expertise is required to ensure a good outcome. The challenges encountered in the management of the airway in this patient are highlighted and discussed.

Keywords: Difficult Airway management; huge mandibular tumour; distortion; low resource