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Trachlight™ management of succinylcholine-induced subluxation of the temporomandibular joint: a case report and review of the literature

Prise en charge avec le trachlight™ d’une subluxation de l’articulation temporo-mandibulaire provoquée par la succinylcholine: présentation de cas et revue de la littérature

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Abstract

Purpose: We present a case of spontaneous subluxation of the temporomandibular joint (TMJ) induced by succinylcholine, to compare our experience with previous cases reported in the literature, and to review the pathophysiology, preoperative screening, and intraoperative management of TMJ instability.

Clinical features: A 39-yr-old female with primary hyperparathyroidism and a normal airway examination presented for elective parathyroidectomy. Following induction of anesthesia and the administration of succinylcholine prior to jaw manipulation, her mouth could not be opened, and we suspected spontaneous subluxation of the TMJ. We secured the airway with the use of a Trachlight™ and, subsequently, reduced the joint. Postoperatively, a history of mild TMJ-related symptoms was elicited.

Conclusion: Instability of the TMJ is not uncommon, and has several implications for airway management, highlighting the importance of preoperative screening. Limited mouth opening, due to spontaneous subluxation of the TMJ following succinylcholine-induced muscle relaxation in the absence of airway manipulation, has only twice been reported in the literature. This report highlights how tracheal intubation may be accomplished using the Trachlight™, in order to secure the airway prior to reduction of the subluxed joint.

Résumé

Objectif: Nous présentons ici un cas de subluxation spontanée de l’articulation temporo-mandibulaire (ATM) provoquée suite à l’administration de succinylcholine, afin de comparer notre expérience à des cas rapportés précédemment dans la littérature, et de revoir la physiopathologie, le dépistage préopératoire et la prise en charge peropératoire de l’instabilité de l’ATM.

Éléments cliniques: Une femme de 39 ans souffrant d’hyperparathyroïdisme primaire mais dont l’examen des voies respiratoires n’avait rien révélé d’anormal a été admise pour une parathyroïdectomie programmée. Après l’induction de l’anesthésie et l’administration de succinylcholine avant de manipuler la mâchoire, la bouche n’a pas pu être ouverte, et nous avons soupçonné une subluxation spontanée de l’ATM. Nous avons intubé la patiente avec un dispositif Trachlight™ et, par la suite, réduit l’articulation. En période postopératoire, on a découvert des antécédents de symptômes bénins associés à une ATM.

Conclusion: L’instabilité de l’ATM est fréquente et a plusieurs conséquences sur la prise en charge des voies respiratoires, soulignant l’importance d’un dépistage préopératoire. Une ouverture limitée de la bouche en raison d’une subluxation spontanée de l’ATM après avoir provoqué une relaxation musculaire avec la succinylcholine et sans manipulation des voies respiratoires n’a été rapportée que deux fois dans la littérature. Cette présentation de cas met en exergue une façon de réaliser une intubation trachéale avec un Trachlight™, afin de sécuriser les voies aériennes, avant de réduire l’articulation subluxée.

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Author information

Correspondence to Derek R. Townsend md frcpc.

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Disclosures: None.

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des Ordons, A.R., Townsend, D.R. Trachlight™ management of succinylcholine-induced subluxation of the temporomandibular joint: a case report and review of the literature. Can J Anesth 55, 616 (2008). https://doi.org/10.1007/BF03021436

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Keywords

  • Tracheal Intubation
  • Succinylcholine
  • Airway Management
  • Laryngeal Mask Airway
  • Temporomandibular Joint