Use of the Bonfils Intubation Fiberscope in Patients with Limited Mouth Opening

• Main Authors: Nabil A. Shollik, Sami M. Ibrahim, Ahmed Ismael, Vanni Agnoletti, Emanuele Piraccini, Ruggero Massimo Corso
• Format: Article
• Language: English
• Published: Hindawi Limited 2012-01-01
• Series: Case Reports in Anesthesiology
• Online Access: http://dx.doi.org/10.1155/2012/297306

Airway management of patients with very limited mouth opening remains a challenge for the anaesthetist. We describe the use of the Bonfils Intubation Fiberscope for awake intubation in two patients with a very limited mouth opening. In the first case, a 60-year-old 80 kg female, scheduled for a right modified radical mastectomy for infiltrating ductal carcinoma (15 mm mouth opening, a short thick neck, limited neck extension, and a Mallampati class 4 airway), the Bonfils was advanced via the retromolar technique. In the second patient, a 34-year-old male, scheduled for a surgical tracheotomy for right tonsillar cancer, due to a neoplastic infiltration of the right temporomandibular joint (7 mm mouth opening and limited neck movement), the Bonfils was advanced using the midline approach. The Bonfils is a reusable, rigid, straight fiberoptic device with a curved tip, is 5 mm in diameter, and has several advantages: it is quick and easy to use, more cost effective than a flexible fiberscope, and is safe in expert hands, thanks to its smaller diameter. Our conclusion is that awake BIF intubation is a reliable, atraumatic, and well-tolerated procedure to secure a safe airway in patients with a limited mouth opening.