• Jirawan Jirakijja M.D.

General anesthesia for patients undergoing surgery in the oral and maxillofacial region may
be complicated. The anesthesiologist frequently faces the condition that makes mask ventilation and
tracheal intubation potentially difficult. A careful preoperative airway assessment and proper preparation
are essential for safe anesthesia. This is a report of two patients with different management of
difficult airway problems. Case I: a 16-year-old man was scheduled for reconstruction of mandible with
titanium reconstruction plate and iliac crest graft. His abnormal anatomic features were short, receding
mandible and fixed tongue which were due to his previous operations. The airway was successfully
secured with a fiberoptic-guided intubation under inhalation anesthesia. Case II: a 75-year-old woman
presented with recent surgical removal of impaction and subsequently developed Ludwigûs angina. She
was scheduled for incision and drainage under general anesthesia. The plan for airway management was
initially to examine the patientûs airway by direct laryngoscopy under intravenous sedation. When
sedatives was administered, the patient became unconscious and developed complete upper airway
obstruction. It was impossible to ventilate the patient via a face mask resulting in desaturation and
bradycardia. Emergency tracheostomy was performed. The surgery was carried out after stabilizing
the patientûs condition. At the end of the procedure the patient was fully awake but exhibited respiratory
insufficiency. She was transferred to the intensive care unit in the Police General Hospital where she
developed cardiovascular complications. However, she was discharged home 2 months after admission
without serious morbidity.

(CU Dent J. 2005;28:51-8)