• Users Online: 1492
  • Print this page
  • Email this page


 
 Table of Contents    
LETTER TO EDITOR
Year : 2014  |  Volume : 58  |  Issue : 1  |  Page : 87-89  

Palatal obturator: Perioperative concerns


Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India

Date of Web Publication13-Feb-2014

Correspondence Address:
Vanita Ahuja
Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Sector 32, Chandigarh
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5049.126840

Rights and Permissions

How to cite this article:
Ahuja V, Kazal S, Sinha S. Palatal obturator: Perioperative concerns. Indian J Anaesth 2014;58:87-9

How to cite this URL:
Ahuja V, Kazal S, Sinha S. Palatal obturator: Perioperative concerns. Indian J Anaesth [serial online] 2014 [cited 2020 Oct 22];58:87-9. Available from: https://www.ijaweb.org/text.asp?2014/58/1/87/126840

Sir,

A 46-year-old male, weighing 60 kg with diabetes mellitus type II since 10 years was scheduled for debridement of the nasal cavity under general anaesthesia (GA). Patient had undergone surgical procedure for mucormycosis under GA uneventfully one year ago. Systemic examination was unremarkable. The airway examination showed a Mallampati (MMP) class IV [Figure 1]a with mouth opening of 3 cm, thyromental distance of 10 cm and possible anterior mandibular protrusion. Patients blood biochemistry and other routine investigations were acceptable. Patient was kept nil per oral and premedicated with anxiolytics and antacids on the night before and on the morning of surgery while morning dose of insulin was omitted. On the day of surgery blood sugar and electrolytes were within the normal range. In the operating room, a multi parameter monitor (AS5, Datex Ohmeda, Finland) was attached to the patient and after securing intravenous (IV) access, IV glycopyrrolate 0.2 mg and IV fentanyl 120 μg were given. Difficult airway cart was kept ready. GA was induced with IV propofol 120 mg and IV succinylcholine 100 mg was given after confirmation of ability to ventilate the lungs. Oral endotracheal intubation was performed with 8.0 mm cuffed endotracheal tube with Glidescope ® (GVL; Verathon Inc., Bothell, WA). During intubation, the posterior end of palatal obturator was visualized. Following correct placement of endotracheal tube, the palatal obturator was removed [Figure 1]b. Rest of the perioperative period was unremarkable.
Figure 1: (a) Airway examination of patient shows a mallampati grade IV. (b) The palatal obturator after removal

Click here to view


Palatal obturator is a prosthetic device and is indicated in patients with cleft palate, traumatic injuries and tumours of palate. [1],[2] Palatal obturator consists of an acrylic plate and retention clasps of orthodontic wire, which covers a fistula of the palate. It serves to restore speech, mastication, deglutition and aesthetics. [1],[2] Successful obturation depends on the volume of the defect, tissue retention available around the cavity and development of muscular control. [3],[4] It must be as light as possible as its weight may act as a dislocating force. [3] The palatal obturator can cause anaesthetic complications including airway obstruction, inability to pass endotracheal tube due to dislodgement of prosthesis, limitation of the space for a laryngoscope and a traumatic intubation.

According to recent practice guidelines for management of the difficult airway, video-assisted laryngoscopy can now be used as an initial approach to intubation in patients in non-emergent pathway with difficult airway. [5] We administered succinylcholine considering uneventful previous anaesthetic exposure of the patient and MMP class IV being the only predictor for difficult airway and rest of the airway examination also being normal. [5] The difficult airway cart with other alternative intubation devices were however kept ready.

The absence of symptoms of regurgitation of food or water, MMP class IV on airway examination and observer limitation of not able to differentiate between similar looking palatal obturator with the oral mucosa in room light; all probably contributed to the cause of missed finding in the present case. However, we did not encounter any complication during the anaesthetic procedure.

Pre-anaesthesia evaluation is considered as basic element of anaesthesia care and includes a multi-disciplinary approach including patient's medical record, history taking, physical examination and findings from medical tests and evaluations. At the same time, anaesthesiologist should consult other health-care professionals to obtain information relevant to perioperative care to avoid any catastrophe. Assessment performed during pre-anaesthetic evaluation may be used to formulate plans for intraoperative care, post-operative recovery, perioperative pain management and patient education. [6]

 
   References Top

1.Keyf F. Obturator prostheses for hemimaxillectomy patients. J Oral Rehabil 2001;28:821-9.  Back to cited text no. 1
[PUBMED]    
2.Hou YZ, Huang Z, Ye HQ, Zhou YS. Inflatable hollow obturator prostheses for patients undergoing an extensive maxillectomy: A case report. Int J Oral Sci 2012;4:114-8.  Back to cited text no. 2
[PUBMED]    
3.Bagis B, Aydoðan E, Hasanreisoðlu U. Rehabilitation of a congenital palatal defect with a modified technique: A case report. Cases J 2008;1:39.  Back to cited text no. 3
    
4.Roumanas ED, Nishimura RD, Davis BK, Beumer J 3 rd . Clinical evaluation of implants retaining edentulous maxillary obturator prostheses. J Prosthet Dent 1997;77:184-90.  Back to cited text no. 4
    
5.Apfelbaum JL, Hagberg CA, Caplan RA, Blitt CD, Connis RT, Nickinovich DG, et al. Practice guidelines for management of the difficult airway: An updated report by the American society of anesthesiologists task force on management of the difficult airway. Anesthesiology 2013;118:251-70.  Back to cited text no. 5
[PUBMED]    
6.Committee on Standards and Practice Parameters, Apfelbaum JL, Connis RT, Nickinovich DG, American Society of Anesthesiologists Task Force on Preanesthesia Evaluation, Pasternak LR, et al. Practice advisory for preanesthesia evaluation: An updated report by the American society of anesthesiologists task force on preanesthesia evaluation. Anesthesiology 2012;116:522-38.  Back to cited text no. 6
[PUBMED]    


    Figures

  [Figure 1]



 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    References
    Article Figures

 Article Access Statistics
    Viewed2074    
    Printed9    
    Emailed0    
    PDF Downloaded266    
    Comments [Add]    

Recommend this journal