Dental implant removal to facilitate suspension laryngoscopy and laser treatment of an obstructed airway.

A 29-year-old patient presented with dysphonia, dysphagia and a progressive history of stridor over 6 weeks. His past medical history included childhood nasolabial rhabdomyosarcoma treated by surgery, chemotherapy and radiotherapy. This had resulted in marked abnormalities of the facial skeleton, limited neck extension and restricted mouth opening of 1 cm, in part due to dental implants. After careful discussion and planning within a multidisciplinary team, the airway was optimised by temporary removal of the dental implants. This enabled a suspension laryngoscope to be passed, permitting carbon dioxide laser treatment to an obstruction at the laryngeal inlet and eliminating the need for a tracheostomy.

The effect of temperature on bougies: a photographic and manikin study.

We investigated the effect of temperature on single use and reuseable bougies. In a photographic study, three bougies (Portex Venn reuseable (R), Portex single use (S) and Breathesafe single use (B)) were exposed to increasing temperatures and sequential photographs were taken of the bougies uncoiling from a preformed curve. Bougie type was associated with rate of uncoiling, type R maintaining its curve the longest but changing temperature did not affect this. In a randomised cross-over manikin study, 16 anaesthetists attempted to pass two bougies (Portex reuseable (R) and Portex single use (S)) at three temperatures (10, 20 and 30 degrees C) into the trachea of a manikin. Type R was significantly associated with higher success rate of tracheal placement compared to type S. Change of temperature was significant with success rate increasing with lower temperature. The odds of success at 10 degrees C was six times that at 30 degrees C (OR (95%) 6.7 (1.7, 25.7)). We concluded that both bougies performed best at 10 degrees C.