A review of anaesthetic technique in 15 paediatric patients with temporomandibular joint ankylosis.

Temporomandibular joint ankylosis presents a serious problem for airway management. This relatively rare problem becomes even more difficult to manage in children because of their smaller mouth opening with near total trismus, and the need for general anaesthesia before making any attempts to secure the airway. A technique for securing the airway that combines local blocks for nerves of larynx and topical anaesthesia of upper airways for placement of these blocks, and minimal general anaesthesia for these manoeuvres, is described. For general anaesthesia, a combination of halothane and ether by spontaneous ventilation, using bilateral nasopharyngeal airways, was used. Because of the severe trismus, a tongue depressor or tip of a laryngoscope was used with a fibreoptic light source in the buccal sulcus to visualize the tracheal tube in the pharynx. Nasal forceps, with a smaller tip and narrower blade than Magill forceps was used to guide the tracheal tube towards the air bubbles coming out of larynx. No attempt was made to visualize the larynx, but its position was guessed from the direction of these air bubbles. We review the anaesthetic technique in 15 such cases of severe trismus managed successfully between 1986 and 1999.