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Anything can Happen in the Surgery

Yusuf Kahya1, Çiğdem Yıldırım Güçlü2, Bülent Mustafa Yenigün1, Hasay Guliyev3 and Ayten Kayı Cangır1*
1Department of Thoracic Surgery, Ankara University School of Medicine, Turkey
2Department of Anesthesiology and Reanimation, Ankara University School of Medicine, Turkey
3Departmentof Otorhinolaryngology, Ankara University School of Medicine, Turkey


*Corresponding author: Ayten Kayı Cangır, Department of Thoracic Surgery, Ankara University School of Medicine, Ibni Sina Hospital, 06100 Sıhhiye, Ankara, Turkey


Published: 20 Nov, 2017
Cite this article as: Kahya Y, Güçlü ÇY, Yenigün BM, Guliyev H, Cangır AK. Anything can Happen in the Surgery. Clin Surg. 2017; 2: 1742.

Keywords

Temporomandibular joint dislocation; Laryngeal mask airway; Bronchoscopy

Clinical Image

Introduction: Fiberoptic Bronchoscopy (FOB) is a safe procedure with a major complication rate of < 1%. In this case, it was aimed to present a rare complication during FOB.
Case presentation: A 19-year-old female patient undergoing diagnostic FOB due to endobronchial lesion of the lower lobe of the left lung was placed in a classical Laryngeal Mask (LMA) no:3 after induction of general anesthesia, followed by FOB. When the LMA was removed after FOB, the anesthesiologist determined that the patient's lower jaw was protruding forward and that the mouth was not closed (Figure 1). Clinically, anterior bilateral Temporomandibular Joint Dislocation (TMJD) was diagnosed and manual reduction was performed intraoperatively by the otorhinolaryngology team (Figures 2 and 3).
Discussion: It has been reported that TMJD may occur with general anesthesia agents and wide opening of the mouth in patients with weak temporomandibular joint capsule due to hypotony in the chewing muscles [1-3]. In our department, this complication was encountered for the first time in 4484 patients who underwent FOB with LMA between 2000-2017. These cases should be reduced by otorhinolaryngology team under general anesthesia [4,5].

Figure 1

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Figure 1
Patient's mouth is left open due to TMJD.

Figure 2

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Figure 2
Reduction process.

Figure 3

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Figure 3
Peroneus brevis tendon after repair with direct tubularization.

References

  1. Kim SK, Kim K. Subluxation of thetemporomandibular joint. Unusual complications of transoral bronchofiberoscopy. Chest. 1983;83(2):288-9.
  2. Kepron W. Bilateral dislocations of thetemporomandibular joint complicating fiberoptic bronchoscopy. Chest. 1986;90(3):465.
  3. British Thoracic Society Bronchoscopy Guidelines Committee, a Subcommittee of Standarts of Care Committee of British Thoracic Society. British Thoracic Society guidelines on diagnostic flexible bronchoscopy. Thorax. 2001;561:i1-21.
  4. Sia SL, Chang YL, Lee TM, Lai YY. Temporomandibular Joint Dislocation after Laryngeal Mask Airway Insertion. Acta Anaesthesiol Taiwan. 2008;46(2):82-5.
  5. Oliphant R, Key B, Dawson C, Chung D. Bilateral temporomandibular joint dislocation following pulmonary function testing: a case report and review of closed reduction techniques. Emerg Med J. 2008;25(7):435-6.