Blind nasal intubation as an alternative airway management modality for bilateral temporomandibular joint ankylosis in a resource constrained set-up: A clinical case report

Introduction and importance: Temporomandibular joint (TMJ) ankylosis is increasing dramatically especially in developing countries due to the delay in treatment and difficulty access to specialized healthcare. Patients usually presents with restricted mouth opening, dentofacial deformity, malocclusion, impaired speech, difficulty in mastication, malnutrition, obstructive sleep apnea, and airway obstruction. Case presentation: This case report presented an 18 year old, 32 kg, 1.50 m female patient diagnosed as bilateral temporomandibular ankylosis and her airway was managed with blind nasal intubation without any apparent perioperative complication. Clinical discussion: Administration of anesthesia and airway management to patients with TMJ ankylosis ideally requires the availability of flexible fibreoptic bronchoscope and trained personnel who use the equipment and monitoring facilities. However, many facilities especially in developing countries are lacking the necessary equipments. Retrograde intubation, tracheotomy and blind intubation are also another possible option for airway management of these patients. Conclusion: We believe that blind nasal intubation can be an alternative airway management modality in resource constrained settings where flexible fibreoptic bronchoscope is not available.