DAS Small Research Grant

University Hospitals Coventry & Warwickshire NHS Trust

Title
Temporomandibular Joint Dysfunction Following the Use of a Supraglottic Airway Device

Amount
£4,090

Scientific Abstract
Supraglottic airway devices (SADs) are commonly used to manage the airway under general anaesthetic. SADs are used by novice and experienced anaesthetists, anaesthetic practitioners, non-anaesthetic clinicians and other health care professionals.

Although insertion of SADs is relatively easy it requires certain manoeuvres to be successful. These include extension of the head, neck flexion, use of a jaw thrust with adequate mouth opening and then introduction of the device with a firm and gentle motion down and backwards along the hard palate (2). Whilst movements such as these can be viewed as simple and 'benign', we are concerned that these can cause dysfunction of temporomandibular joint in the postoperative period.

Most published research has been focused on insertion success and time taken to insert the device (3). Limited evidence is available on complications such as gastric aspiration and trauma to or loss of the airway (1). There are some case reports of TMJ dysfunction and dislocation following general anaesthesia and SAD insertion (4,5,6). We hypothesise a degree of dysfunction can occur due to passive manipulation of the TMJ with forward movement of the jaw and widened mouth opening for a prolonged time.

References:
(1) Cook TM, Woodall N, Frerk C, et al. Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Major Complications of Airway Management in the United Kingdom. NAP 4 Report. https://www.niaa.org.uk/NAP4-Report?newsid=513#pt

(2) Sorbello M, Petrini F. Supraglottic Airway Devices: the Search for the Best Insertion Technique or the Time to Change Our Point of View? Turk J Anaesthesiol Reanim. 2017 Apr; 45(2): 76-82.

(3) Michalek P, Donaldson W, et al. Complications Associated with the Use of Supraglottic Airway Devices in Perioperative Medicine. Biomed Res Int. 2015; 746560.

(4) Jasani V, Ahmed S, Avery C. Comparison of temporomandibular joint dysfunction following wisdom tooth extraction under general anaesthesia to local anaesthesia. British Journal of Oral and Maxillofacial Surgery. 2012; 50: S62

(5) Sia SL, Chang YL, et al. Temporomandibular joint dislocation after laryngeal mask airway insertion. Acta Anaesthesiol Taiwan. 2008 June; 46 (2): 82-5

(6) Bhandari S, Swain B, et al. Temporomandibular Joint Dislocation After LMA Insertion. The Internet Journal of Anesthesiology Volume 16 Number 1