Anaesthetic Management of Temperomandibular Joint Ankylosis in Paediatrics: A 5 Year Audit in a University Hospital

Temporomandibular joint (TMJ) ankylosis presents significant challenges for airway management, more so in children due to the inherent differences in their physiology and airway anatomy. Techniques used to secure airway in adults may not be ideal for children and sometimes dedicated equipment may not be available. We conducted a 5 year audit to analyse different techniques used to manage these patients in our hospital. Although TMJ ankylosis is well known to be associated with difficult airway management, the techniques used are dependent on the expertise of the concerned anaesthesiologists and available resources most of the time. The aim of our audit was to determine the incidence of difficulty in airway management during TMJ ankylosis repair in paediatric age groups well as look for the incidence of comorbidities and complications. We retrospectively audited cases of TMJ ankylosis amongstpaediatric population over a 5-year period in our institution, recording demographics, comorbidities, postoperative complications, anaesthetic techniques including difficulty inventilation and airway management strategies. We report a total of 32 patients, 16 belonging to the paediatric age in comparison with 16 adult patients operated for ankylosis release. Different techniques used and outcomes have been studied in this audit. A range of anaeshtetic techniques were employed for induction, maintenance and extubation. There was intubation difficulties recorded at induction of one patient. Our audit revealed that even though different techniques were employed by different anaesthesiologists, awake fiberoptic intubation or with mild sedationstill remained the first choice for intubation in TMJ ankylosis with.