- Email: [email protected]
TMJ assessment before anaesthesia
Correspondence
TMJ assessment before anaesthesia EditorÐAgro and colleagues1 appropriately call for inclusion of assessment of temporomandibular joint (TMJ) function in the preoperative evaluation of the airway. I would like to point out that the newly published second iteration of the American Society of Anesthesiologist's Dif®cult Airway Algorithm already includes assessment of TMJ function in two ways.2 First, step 3 of the preoperative evaluation plan determines the ability of the patient to voluntarily prognath the mandibular teeth anterior to the maxillary teeth, which is a test of TMJ mobility. Secondly, step 4 of the evaluation plan, which determines interincisor distance, is also a test of TMJ mobility. I look forward to continued study of the relationship between laryngoscopy/tracheal intubation and TMJ function, particularly with respect to the ability of the patient to prognath, and to the measurement of interincisor distance. J. L. Benumof San Diego, USA
F. E. AgroÁ Rome, Italy 1 Agro F, Salvinelli F, Casale M, Antonelli S. Temporomandibular joint assessment in anaesthetic practice. Br J Anaesth 2003; 50: 707±8 2 Caplan RA, Benumof JL, Berry FA, et al. Practice Guidelines for Management of the Dif®cult Airway: An Updated Report by the American Society of Anesthesiologists Task Force on Management of the Dif®cult Airway. Anesthesiology 2003; 98: 1269±77
DOI: 10.1093/bja/aeg634
757
Downloaded from http://bja.oxfordjournals.org/ at University of Michigan on April 19, 2015
EditorÐWe wish to thank Professor Benumof for pointing out that the new Practice Guidelines for Management of the Dif®cult Airway include assessment of TMJ function in the preoperative evaluation plan.2 Our preliminary study1 demonstrated that tracheal intubation could cause new onset TMJ dysfunction, or worsening of misdiagnosed TMJ disorders. It also showed that dysfunction of the TMJ is not an uncommon cause of dif®cult intubation in patients with a normal airway. We agree with Professor Benumof that it is important to continue further study of the relationship between laryngoscopy/tracheal intubation and TMJ function. In our opinion, an alternative laryngoscopy and intubation technique should be considered in patients with TMJ dysfunction when it is detected in the preoperative evaluation plan.
TMJ assessment before anaesthesia EditorÐAgro and colleagues1 appropriately call for inclusion of assessment of temporomandibular joint (TMJ) function in the preoperative evaluation of the airway. I would like to point out that the newly published second iteration of the American Society of Anesthesiologist's Dif®cult Airway Algorithm already includes assessment of TMJ function in two ways.2 First, step 3 of the preoperative evaluation plan determines the ability of the patient to voluntarily prognath the mandibular teeth anterior to the maxillary teeth, which is a test of TMJ mobility. Secondly, step 4 of the evaluation plan, which determines interincisor distance, is also a test of TMJ mobility. I look forward to continued study of the relationship between laryngoscopy/tracheal intubation and TMJ function, particularly with respect to the ability of the patient to prognath, and to the measurement of interincisor distance. J. L. Benumof San Diego, USA
F. E. AgroÁ Rome, Italy 1 Agro F, Salvinelli F, Casale M, Antonelli S. Temporomandibular joint assessment in anaesthetic practice. Br J Anaesth 2003; 50: 707±8 2 Caplan RA, Benumof JL, Berry FA, et al. Practice Guidelines for Management of the Dif®cult Airway: An Updated Report by the American Society of Anesthesiologists Task Force on Management of the Dif®cult Airway. Anesthesiology 2003; 98: 1269±77
DOI: 10.1093/bja/aeg634
757
Downloaded from http://bja.oxfordjournals.org/ at University of Michigan on April 19, 2015
EditorÐWe wish to thank Professor Benumof for pointing out that the new Practice Guidelines for Management of the Dif®cult Airway include assessment of TMJ function in the preoperative evaluation plan.2 Our preliminary study1 demonstrated that tracheal intubation could cause new onset TMJ dysfunction, or worsening of misdiagnosed TMJ disorders. It also showed that dysfunction of the TMJ is not an uncommon cause of dif®cult intubation in patients with a normal airway. We agree with Professor Benumof that it is important to continue further study of the relationship between laryngoscopy/tracheal intubation and TMJ function. In our opinion, an alternative laryngoscopy and intubation technique should be considered in patients with TMJ dysfunction when it is detected in the preoperative evaluation plan.