P173 Coping with unexpected TMJ lock: transitioning from general to regional anesthesia for clavicle surgery

<h3></h3> <b>Please confirm that an ethics committee approval has been applied for or granted</b>: Not relevant (see information at the bottom of this page) <h3>Background and Aims</h3> We aim to present a case of clavicle surgery which started with general anesthesia(GA) induction followed by ‘cannot intubate’ scenario due to temporomandibular joint(TMJ) lock. We switched to ultrasound guided(USG) regional anesthesia and case was operated successfully. <h3>Methods</h3> A 35-year-old patient with history of previous uncomplicated GA was scheduled for implant removal surgery from left clavicle under GA. Following standard monitorization, GA induction was carried out with fentanyl, propofol and rocuronium. After uneventful facemask ventilation, laryngoscopy was attempted but severe mouth restriction was encountered. Additional rocuronium was administered, but problem persisted and patient wasn’t intubated but was safely awakened. USG interscalene, superficial cervical plexus, and clavipectoral blocks were applied and patient was operated uneventfully. <h3>Results</h3> Normal TMJ function relies on coordinated muscle contractions around a condyle and disc complex (1). Deformation in the joint, coupled with muscle relaxation after general anesthesia, can result in jaw locking and may result in a difficult airway(DA). According to the current DA algorithm, if the patient cannot be ventilated and intubated, options include awakening the patient and deferring procedure, using regional anesthesia, or employing awake fiberoptic techniques (2). Sensory innervation of clavicle occurs via cervical and brachial plexuses (3). In our case, we applied interscalene, superficial cervical, and clavipectoral blocks, ensuring successful surgical anesthesia. <h3>Conclusions</h3> We believe that thorough preoperative evaluation with detailed history and physical examination combined with the use of regional techniques in case of potential DA result in a successful surgical anesthesia.