CERVICOFACIAL CELLULITIS OF DENTAL ORIGIN AND ENDOTRACHEAL INTUBATION

Objectives: To evaluate the difficulty of intubation in relation with the localisation and spread of cervico-facial cellulitis of odontogeni c origin and to recognize the optimal technique of intubation in such circumstances. Study design: Prospective clinical open study. Patients : Hundred patients, including 16 children, undergoing surgical drainag e of a cervico-facial cellulitis of odontogenic: origin under general anesthesia were studied. Methods: Difficulty of intubation was evaluat ed with the following four criteria: active mouth opening in the awake patient, Mallampati's classifying system, presence of trismus, clinic al and radiological control of localisation and extension of the cellu litis (mandibular, maxillar or mouth floor). In case of a foreseen dif ficult intubation, a fibrescope was used in the awake patient. Otherwi se the endotracheal tube was inserted after administration of propofol (3 mg . k(-1)) and alfentanil (10 to 20 mu g . kg(-1)). A Cormack's g rading was performed during intubation. Results: Mouth opening depende d on the localisation of the cellulitis. Trismus occurred more often w ith mandibular than maxillary localisations. Trismus and a Mallampati' s class > 2 were associated with difficulty in intubation (Cormack's g rade > 2), except in maxillary localisations. Conclusions: The localis ation of cellulitis of odontogenic origin is responsible for the diffi culty grade of intubation. Awake fibreoptic intubation should be syste matically performed in patients with a floor of the mouth cellulitis t o reduce the risk of rupture of the abscess by a laryngoscope blade. A s trismus associated with mandibular localisations is not relieved by general anaesthesia, awake fibreoptic endotracheal intubation should b e preferred.