Kiểm soát đường thở bằng mặt nạ thanh quản proseal ở bệnh nhân sẹo co kéo cằm cổ nặng sau bỏng trong phẫu thuật chuyển vạt: Báo cáo ca bệnh

Abstract

Introduction: Patients with post-burn mentocervical contractures may present with an anticipated difficult airway due to anatomical distortion, restricted mouth opening, and limited neck mobility. We report a case of airway management using a ProSeal laryngeal mask airway (LMA) during flap reconstruction requiring supine-prone-supine repositioning.
Case presentation: A 16-year-old male patient with severe post-burn mentocervical contracture following high-voltage electrical burns presented with an inability to extend his neck, a maximum mouth opening of 2.5 cm, and Mallampati class IV. The patient underwent pedicled musculocutaneous flap reconstruction for a mandibular defect. Following induction of anesthesia, a size 3 ProSeal LMA was successfully inserted on the first attempt. Effective ventilation was confirmed by capnography and bilateral breath sounds. Mechanical ventilation was maintained throughout the 220-minute procedure, including supine-prone-supine repositioning. Intraoperative SpO₂ ranged from 96% to 100%, and peak airway pressure ranged from 19 to 22 cmH₂O. No loss of ventilation or device displacement was observed during repositioning. The ProSeal LMA was removed after the patient regained consciousness. No airway obstruction or laryngospasm was reported during the first 24 postoperative hours.
Conclusion: The ProSeal LMA may be a feasible airway management option in carefully selected patients with severe post-burn mentocervical contractures, provided that appropriate airway assessment, backup strategies, and close ventilation monitoring are ensured, particularly during patient repositioning. A single case report cannot establish general safety or justify broader indications.