The authors encountered a case involving difficult intubation during anesthesia\nfor revision of cervical fixation angle in a 62-year-old woman, with a history\nof chronic rheumatoid arthritis, who experienced dysphagia after initial\nposterior occipitocervical fusion to correct atlantoaxial subluxation. Two days\nafter initial surgery, she developed trismus with neck flexion and dysphagia,\nand underwent revision surgery. General anesthesia was planned; however,\ntracheal intubation using the McGrath laryngoscope and bronchofiberscope\nwas difficult, which prolonged anesthesia induction. Narrowing of the oral\nand pharyngeal cavities associated with overcorrection of the cervical spine\nwas believed to be the reason for difficulty in manipulating the tracheal intubation\ndevices. In posterior occipitocervical fusion, intraoperative evaluation\nof the occipito-second cervical vertebra (O-C2) angle is reported to be useful\nin preventing postoperative dyspnea and/or dysphagia, and avoids the need\nfor revision of fixation angle. However, when revision surgery is needed, selection\nof airway management methods and tracheal intubation devices are\nimportant considerations because patients are likely to have restricted mobility\nin the cervical spine and narrowing of the oral and pharyngeal cavities.
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