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Awakenasal fiberoptic bronchoscope (FOB) guided intubation is the gold standard of airway management in patients withtemporomandibular joint ankylosis. It is essential to sufficiently anesthetize the upper airway before the performance of awake FOB guided intubation in order to ensure patient comfort and cooperation and maintain haemodynamics. This randomized controlled study was performed to compare two methods of airway anesthesia, namely topical nebulization of local anesthetic and performance of airway blocks. Materials and methods: Consent was obtained from 46 adult patients of temporomandibular joint ankylosis, scheduled for gap arthroplasty. They were enrolled for thisdouble-blind, randomized, prospective clinical trial with two treatment groups – Group N and Group NB, of 23 patients each. Group N received airway anesthesia through jet nebulization of 10 ml of 4% lignocaine and Group NB received airway blocks (bilateral superior laryngeal and transtracheal recurrent laryngeal) each with 2 ml of 2% lignocaine aswell as topicalairway spray with 4% lignocaine. FOB guided nasotracheal intubation was then performed. Hemodynamic variables at baseline and during the procedure, patient recall and comfortbefore and after intubation, vocal cord visibility, conditions achieved at endoscopy, coughing/gagging episodes, and postoperative events were noted. Results:The success rate of awakefiberoptic intubation was 100%.The haemodynamic parameters, endoscopic conditions and patient response and comfortwas better with nerve block group than nebulization group. Most of the intubations were carried out in less than 3 minutes, however the time taken in group NB was less than in group N. Vocal cord visibility and ease of intubation were better in patients who received airway blocks and hence the amount of supplemental lignocaine used was less in this group.Conclusion: Both ways of topical anaesthesia of airway nebulisation with lignocaine and nerve block technique are satisfactory. However fiberoptic nasal intubation using nerve block technique provides better intubating conditions, patient satisfaction, haemodynamic stability with minimal complications.

iosr journal of dental and medical sciences

Topical Airway Anaesthesia Techniques In Dental Patients With Temporomandibular Joint Ankylosis: A Comparison Between Nebulization Versus Nerve Blocks For Awake Nasal Fiberoptic Intubation