Bilateral mandibular nerve injury following mask ventilation: a case report

Tuncali, Bahattin; Zeyneloglu, Pinar

doi:10.1016/j.bjane.2018.01.005

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Revista Brasileira de Anestesiologia

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Sumário

Clinical Information • Rev. Bras. Anestesiol. 68 (4) • Jul-Aug 2018 • https://doi.org/10.1016/j.bjane.2018.01.005 copy

Bilateral mandibular nerve injury following mask ventilation: a case report

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background and objectives

Nerve injury following mask ventilation is a rare but serious anesthetic complication. The majority of reported cases are associated with excessive pressure applied to the face mask, long duration of mask ventilation, excessive digital pressure behind the mandible to relieve airway obstruction and pressure exerted by the plastic oropharyngeal airway.

Case report

We present a case of bilateral mandibular nerve injury following mask ventilation with short duration, most likely due to a semi-silicone facemask with an over-inflated cushion.

Conclusion

An over-inflated sealing cushion of a facemask may trigger difficult mask ventilation leading to mandibular nerve injury following mask ventilation. Alternative airway management techniques such as laryngeal mask airway should be considered when airway maintenance can only be achieved with strong pressure applied to the facemask and/or mandible.

KEYWORDS
Mandibular nerve injury; Mask ventilation; Anesthesia

Author	Patient	Age	Sex	Surgical procedure	Difficult MV	Duration of MV (min)	Nerve injury	Possible cause	Onset of symptoms	Full recovery
Fuller et al.¹1 Fuller JE, Thomas DV. Facial nerve paralysis after general anesthesia. J Am Med Assoc. 1956;162:645. (1956)	1	54	F	Cholecystectomy	(+)	30 min	Facial nerve	Direct pressure on the mask and strong forward traction of the mandible	After recovery period	After 3 months
	2	53	M	Inguinal hernia repair	(+)	10 min			24 h	Within 3 weeks
Azaar et al.²2 Azar I, Lear E. Lower lip numbness following general anesthesia. Anesthesiology. 1986;65:450-1. (1986)	3	44	F	Dilatation and curettage	(-)	30 min	Mental nerve	Excessive pressure of the mask and airway on the mental and inferior alveolar nerves respectively	24 hur	Within 5 weeks
	4	47	F	Incision of breast mass	(-)	45 min			24 h	After 45 days
Glauber³3 Glauber DT. Facial paralysis after general anesthesia. Anesthesiology. 1986;65:516-7. (1986)	5	54	M	Arthroscopic menisectomy of the knee	(+)	75 min	Facial nerve	Lifting the jaw forward by bilateral digital pressure	24 h	Over 5 weeks
Gimmon⁴4 Gimmon Z. Neuropraxia of the mental nerve. Anaesthesia. 1988;43:613. (1988)	6	35	F	Right hemicolectomy	(-)	?	Mental nerve	Compression by the extraoral part of the tracheal tube and traction by it's fixation technique	24 h	Over 5 weeks
Ananthanaryan et al.⁵5 Ananthanarayan C, Rolbin SH, Hew E. Facial nerve paralysis following mask anaesthesia. Can J Anaesth. 1988;35:102-3. (1988)	7	19	M	Circumcision	(-)	?	Facial nerve	Direct pressure by mask on the nerves, pressure behind the mandible to relieve airway obstruction, oral airway, anatomical variations	?	After 10 days
	8	48	F	Breast biopsy	(-)	45 min			24 h	Within 4 weeks
	9	58	M	Cystoscopy and hydrocelectomy	(-)	?			48 h	Within 3 months
Lorentz et al.⁸8 Lorentz A, Podstawski H, Osswald PM. Numbness of the lower lip following general anesthesia. Anaesthesist. 1988;37:381-3. (1988)	10	40	F	Derotation osteotomy of femur	(+)	5-6 min	Mental nerve	Considerable pressure exerted on the mask	24 h	Within 6 weeks
Bhuiyan et al.⁶6 Bhuiyan MS, Chapman M. Mental nerve injury following facemask anaesthesia. Anaesthesia. 2006;61:516-7. (2006)	12	43	F	Excision of Mortons' neuroma	(+)	30 min	Mental nerve	Excessive pressure of the mask on the lower lip against mandible	24 h	Within 3 weeks
Richa et al.⁷7 Richa F, Yazigi A, Yazbeck P. Mental nerve injury following general anaesthesia. Eur J Anaesthesiol. 2008;25:951. (2008)	11	31	F	Gynecologic laparoscopy	(-)	45 min	Mental nerve	Pressure applied by the airway on the mental branch of the inferior alveolar nerve	24 h	Within 2 weeks
Baidya et al.⁹9 Baidya DK, Bhoi D, Sinha R, et al. Partial facial nerve paralysis after laparoscopic surgery under general anaesthesia. Indian J Anaesth. 2011;55:416-8. (2011)	13	62	F	Laporoscopic hysterectomy and cholecystectomy	(+)	3 min	Mental, buccal nerves	Forward digital pressure at the right angle of the jaw	24 h	After 6 weeks

Sociedade Brasileira de Anestesiologia R. Professor Alfredo Gomes, 36, 22251-080 Botafogo RJ Brasil, Tel: +55 21 2537-8100, Fax: +55 21 2537-8188 - Campinas - SP - Brazil
E-mail: bjan@sbahq.org

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[1] * Corresponding author. E-mail:tuncali.bahattin@gmail.com (B. Tuncali).