SURGICAL RELEASE FOR INTUBATION PURPOSES IN POSTBURN CONTRACTURES OF THE NECK

Postburn contractures of the neck can cause difficult endotracheal int ubation when cervical hyperextension and lifting of the mandible are i mpaired. Alternative techniques to direct laryngoscopy may be hampered by the presence of rigid scar tissue which obscures the mandibular an d laryngeal anatomy, or by the presence of microstomia following retra ction of scar tissue in facial burns. This report describes our experi ence with a safe and quick surgical neck release to facilitate endotra cheal intubation in such cases. Following release, intubation was esta blished at the first attempt in all cases. Patients who have suffered flame burns to the thorax with an ascending involvement of the neck an d mandibular region are particularly prone to develop extreme contract ures. Problems with intubation should be anticipated in patient with h ealed burns of the neck, and equipment for aiding intubation should be on hand. Furthermore, the surgeon must be available during the induct ion of anaesthesia to perform an emergency neck release if necessary. (C) 1996 Elsevier Science Ltd for ISBI.