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Year : 2011  |  Volume : 5  |  Issue : 4  |  Page : 442-443

An alternative to bite block in a patient with restricted mouth opening

Department of Anaesthesia and Intensive Care, Jai Prakash Narayan Apex Trauma Centre (JPNATC), All India Institute of Medical Sciences (AIIMS), New Delhi, India

Correspondence Address:
Pramendra Agrawal
Senior Resident, Anesthesiology, A 148, Sector 15, Noida - 201 3 01, Uttar Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1658-354X.87282

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Date of Web Publication8-Nov-2011

How to cite this article:
Sawhney C, Agrawal P, Soni KD, Ramchandani S, Sinha C. An alternative to bite block in a patient with restricted mouth opening. Saudi J Anaesth 2011;5:442-3

How to cite this URL:
Sawhney C, Agrawal P, Soni KD, Ramchandani S, Sinha C. An alternative to bite block in a patient with restricted mouth opening. Saudi J Anaesth [serial online] 2011 [cited 2022 Aug 13];5:442-3. Available from:


Awake fiberoptic intubation forms an integral part of algorithm for the management of difficult airway. We report a case wherein the barrel of a 20-ml syringe was used as bite block in a patient with restricted mouth opening.

A 25-year-old male was posted for lip reconstruction surgery under general anesthesia. Patient was a follow-up case of maxillofacial injury. Evaluation of the airway showed mouth opening was less than one-and-a-half fingers. Both the nostrils were grossly distorted. Anticipating difficult intubation, it was decided to perform awake fiberoptic guided intubation. Prior to fiberoptic bronchoscopy (FOB), adult size bite block insertion was tried but failed due to limited mouth opening. Pediatric bite block was available, but it could not accommodate an endotracheal tube (ETT) of 8.5 mm internal diameter (ID). Barrel of a 20-ml syringe was then cut and used [Figure 1] as bite block to accommodate the 8.5-mm-ID ETT [Figure 2]. It snuggly fitted in the interincisor gap. Induction of anesthesia then proceeded successfully.
Figure 1: Barrel of a 20-ml syringe

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Figure 2: Barrel accommodating ETT

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Fiberoptic aided intubation can be performed orally or nasally. Although nasotracheal intubation is easier as compared to orotracheal, it was not possible in our patient due to distorted nostrils. During awake fiberoptic intubation, a bite block is required to prevent occlusion of the tracheal tube and damage to the fiberoptic endoscope and to keep the mouth open for suctioning. [1],[2] Pediatric bite block use would have necessitated insertion of small size ETT, resulting in increased airway resistance and work of breathing. A variety of bite blocks are available [Figure 3], each having its own advantages and disadvantages. Various oropharyngeal airways like Berman II, ovassapian fiberoptic intubating airway and Patil Syracuse are also available which can serve as an aid to intubation. [3] However, in the absence of these accessories, the barrel of a 20-ml syringe can also be used as bite block to accommodate an appropriate size ETT during FOB.
Figure 3: Bite blocks

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  References Top

1.Popat M. Practical fibreoptic intubation. Oxford: Butterworth-Heinemann; 2001.  Back to cited text no. 1
2.Stackhouse RA. Fiberoptic airway management. Anesthesiol Clin North Am 2002;20:930-51.  Back to cited text no. 2
3.Ovassapian A. Fiberoptic tracheal intubation in adults. In: Ovassapian A, editor. Fiberoptic endoscopy and the difficult airway. Philadelphia: Lippincott-Raven; 1996.  Back to cited text no. 3


  [Figure 1], [Figure 2], [Figure 3]


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