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LETTERS TO EDITOR
Year : 2017  |  Volume : 18  |  Issue : 2  |  Page : 89
 

The “Open Jaw” Mask ventilation: An effective technique in patients with loose tooth


Department of General Anaesthesia, Institute of Critical Care and Anaesthesiology, Medanta The Medicity, Gurugram, Haryana, India

Date of Web Publication12-Dec-2017

Correspondence Address:
Dr. Jyotirmoy Das
Institute of Critical Care and Anaesthesiology, Medanta The Medicity, Gurugram, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/TheIAForum.TheIAForum_33_17

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How to cite this article:
Das J, Kumar S, Khanna S, Mehta Y. The “Open Jaw” Mask ventilation: An effective technique in patients with loose tooth. Indian Anaesth Forum 2017;18:89

How to cite this URL:
Das J, Kumar S, Khanna S, Mehta Y. The “Open Jaw” Mask ventilation: An effective technique in patients with loose tooth. Indian Anaesth Forum [serial online] 2017 [cited 2019 Sep 19];18:89. Available from: http://www.theiaforum.org/text.asp?2017/18/2/89/220559


Sir,

The presence of loose tooth is a concern for the anesthesiologists during oxygenation and laryngoscopy. Although patients are routinely explained about the risk of inadvertent tooth damage or even the need for extraction, still the resultant cosmetic disfigurement and possibility of tooth misplacement into the oropharynx or laryngopharynx keep the anesthesiologists on their toes. Various techniques have been described to save the tooth especially the loose incisors during laryngoscopy like tying the tooth at its base by a suture or using molar approach [1] or paraglossal approach [2] to intubation with various blades. However, the preliminary stage of mask ventilation is often overlooked and is not been adequately addressed by researchers till now. Mask ventilation can itself be enough to dislodge a loose tooth by the shear pressure of the mask cushion on the lower jaw or the pressure and friction on the incisors and canine teeth of the lower jaw by the upper jaw or vice versa. Not much information is available in the literature on the “tooth saving” technique of mask ventilation.

We at our clinical practice are following a modified technique of mask ventilation in patients with loose incisors or canines – the open jaw technique. After preoxygenation, when anesthesia is induced, we open the mouth of the patient by jaw thrust and keep it open without letting the anterior part of both the jaws bearing the incisor and canine teeth touch one another [Figure 1]. This way the pressure on the loose tooth during mask ventilation that would otherwise be exerted by a closed mouth technique is avoided. In our experience, this carries a great safety profile in terms of protecting the loose tooth and at the same time allows easy mask ventilation. We hope the anesthesia fraternity would benefit from our technique which we fondly call the “Medanta Awe.”
Figure 1: (a and b) Open jaw mask ventilation in patients with loose tooth – the “Medanta Awe” technique

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Gupta N, Karunagaran P, Pawar M. Approach to loose teeth: An alternative solution. Indian J Anaesth 2010;54:178-9.  Back to cited text no. 1
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2.
Huang YF, Ting CK, Chang WK, Chan KH, Chen PT. Prevention of dental damage and improvement of difficult intubation using a paraglossal technique with a straight miller blade. J Chin Med Assoc 2010;73:553-6.  Back to cited text no. 2
    


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