Airway Management of Odontogenic Infection Using a Frova Introducer during the COVID-19 Pandemic: A Case Report on Challenging Nasotracheal Intubation

Abstract

Background: Airway management in patients with odontogenic infections is challenging due to edema, trismus, laryngeal deviation, and bleeding. Awake fiber-optic intubation is the gold standard for predicted difficult airway, but during the COVID-19 pandemic, it was discouraged due to aerosol generation. Case Presentation: We report a 52-year-old male with a right mandibular dental abscess causing trismus and sepsis. Preoperative assessment indicated a potentially difficult airway, but mask ventilation was predicted to be feasible. The patient underwent nasotracheal intubation under videolaryngoscopic guidance following rapid sequence induction with etomidate and rocuronium. Initial attempts using the Frova introducer were unsuccessful due to an anteriorly positioned glottis. By retracting the Frova introducer within the nasotracheal tube, an upward movement of the tube tip was achieved, allowing successful intubation without trauma. Surgery proceeded without complications, and the patient was extubated safely postoperatively. Discussion: In odontogenic infections, airway compromise can progress rapidly, and fiberoptic intubation may be suboptimal during COVID-19 due to aerosolization and limited patient cooperation. The combination of videolaryngoscopy and Frova introducer retraction is a rapid, safe, and cost-effective alternative for patients with limited mouth opening, provided that appropriate backup plans and emergency equipment are in place. Conclusion: This case highlights an effective alternative to awake fiberoptic intubation for selected patients with odontogenic infections, emphasizing patient safety, staff protection, and first-pass success.