顎関節症および咀嚼筋腱・腱膜過形成症による麻酔導入後の開口障害に対し歯科用バイトブロックが有用であった1症例

Successful Airway Management with a Dental Bite Block in a Patient with Reduced Mouth-opening after General Anesthesia Induction due to A Temporomandibular Disorder and Masticatory Muscle Tendon-aponeurosis Hyperplasia

要旨

　開口障害は，喉頭展開や気管挿管困難の危険因子となり，術前の重要な気道評価項目である。われわれは全身麻酔導入後に開口障害が増悪し手術中止となった症例に対し，全身麻酔導入前に歯科用バイトブロックを用いて最大開口位を維持し，安全に経口挿管および手術を施行することができた。

　A 49-year-old woman with a history of mouth-opening difficulty after anesthesia induction was scheduled for a tonsillectomy due to immunoglobulin A nephropathy. Prior to a previous surgery, her mouth-opening ability was two fingers wide；after anesthesia induction, it was one finger wide. The patient was diagnosed with masticatory muscle tendon-aponeurosis hyperplasia and temporomandibular joint disorder Ⅲb. We inserted a dental bite block before anesthesia induction to maintain the maximum mouth opening. Oral intubation and tonsillectomy were then performed safely. In cases in which trismus is suspected, the insertion of a dental bite block may be useful for maintaining the patient’s maximum mouth-opening and preventing difficult intubation.