Airway situation
Limited mouth opening / trismus
Type: Anatomic
Before
- Assess mouth opening, floor-of-mouth swelling, voice, drooling, neck mobility, and progression.
- Call ENT/anesthesia early if oral access is limited or swelling is progressive.
- Plan nasal/fiberoptic/awake/surgical pathway depending on anatomy and local expertise.
During
- Avoid repeated oral VL attempts if mouth opening is inadequate.
- Maintain spontaneous ventilation when the plan depends on tenuous anatomy.
- Have suction and surgical backup ready.
After
- Treat infection/trauma source and monitor edema progression.
- Document mouth opening, approach, and backup plan for future teams.
- Extubation should be planned, not automatic.
Pitfalls
- Discovering trismus only after paralytic.
- Forcing oral devices through inadequate mouth opening.
- Delayed specialty mobilization.