Detailed Review of CT Scans Aids Assessment of the Airway in Patients Scheduled for Maxillofacial Surgery

Abstract

Two cases are presented that illustrate the importance of information gained from CT scans of the head and neck taken in patients presenting for maxillo-facial surgery. The first case involved a 25 year old with a massive tumour filling his mouth. Pre-operative assessment was done without reviewing the CT scans of his head and neck. This was unfortunately overlooked as the CT scans were not available at the patient's bedside when the pre-operative assessment was carried out. An awake nasal fibreoptic intubation was planned but this was unsuccessful as the scope could not be passed through the nasopharynx. Review of the CT scan showed severe narrowing of the nasopharynx and a tracheostomy was done under local anaesthesia prior to anaesthetizing the patient. No attempt would have been made to carry out a fibreoptic intubation if the CT scan had been studied earlier and the narrowing of the pharynx appreciated.
The second case involved a 12 year old girl with massive fibreosseous lesions involving the maxilla and mandible. The maxillary lesion had been excised two years previously when the child was 10 years old. At that time a tracheostomy was done, as attempted intubation was unsuccessful. On this occasion, detailed study of her CT scans showed that the left nostril was indented and occluded by the fibreosseous lesion but the right nostril, though narrow, was patent. Under sedation, a nasal fibreoptic intubation was successfully done through the right nostril.