Abstract
The purpose of this article is to review the functional anatomy of the temporomandibular joint (TMJ) mechanism in man, to discuss the various types of TMJ dysfunction and to suggest a plan for assessment, anaesthesia and airway management when reconstructive or unrelated surgery is required. Patients with restricted mouth opening, who require critical care treatment of severe upper airway obstruction or impending ventilatory failure are a special risk group. Regional anaesthesia or the use of a laryngeal airway should be considered. When tracheal intubation is essential and mouth opening is less than 25 mm, it is unlikely that the larynx will be visualized by direct laryngoscopy. Fibreoptic intubation is then indicated. All patients with severe TMJ dysfunction require assessment by an oral surgeon.
Résumé
Le but de cet article est de reviser l’anatomie fonctionnelle du mécanisme de l’articulation temporomandibulaire (TMJ) chez l’homme, de discuter les différentes sortes de dysfonctionnements du TMJ et de suggérer une conduite à tenir face aux voies respiratoires, à l’évaluation et à l’anesthésie lors d’une chirurgie de reconstruction ou lors de toute autre chirurgie. Les patients qui présentent une ouverture restreinte de la bouche, qui ont besoin de soins critiques lors d’une obstruction sévère des voies respiratoires supérieures ou lors d’une défaillance ventilatoire imminente, font partie d’un groupe spécial à risque. L’anesthésie régionale ou l’utilisation d’un masque laryngé devraitêtre considérées. Lorsque l’intubation endotrachéale est essentielle et que l’ouverture de la bouche est moins de 25 mm, il est peu probable que le larynx soit visualisé par laryngoscopie directe. Une intubation à l’aide d’un bronchoscope à fibres optiques est alors indiquée. Tous les patients avec un dysfonctionnement sévère du TMJ nécessitent une évaluation par un chirurgien buccal.
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Aiello, G., Metcalf, I. Anaesthetic implications of temporomandibular joint disease. Can J Anaesth 39, 610–616 (1992). https://doi.org/10.1007/BF03008329
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DOI: https://doi.org/10.1007/BF03008329