The use of mandibular nerve block to predict safe anaesthetic induction in patients with acute trismus.

Abstract

Acute trismus can be caused by pain, muscle spasm, swelling or mechanical obstruction. Unfortunately, the cause is not always obvious during pre-operative airway assessment. In this pilot study, we prospectively evaluated mandibular nerve block as a pre-operative tool to identify patients with reversible causes of trismus, namely pain or spasm, in order to allow safe anaesthetic induction. Six patients with unilateral fractured mandibles and trismus received a mandibular nerve block before induction of general anaesthesia. There was an increase in maximal inter-incisor gap after the blocks (median (range) distance: pre-block 16.5 (14-30) and post-block 34 (32-35) mm; p = 0.027), and no further improvement after induction of general anaesthesia (post-induction 37 (30-40) mm; p = 0.276 compared with post-block). There was an improvement in pain scores (p = 0.027), and no side-effects were detected. Pre-operative mandibular nerve blockade appears to reverse trismus caused by pain and muscle spasm, allowing the anaesthetist to decide whether awake intubation is genuinely indicated.