TAScope, an Indian Jugad for Difficult Intubations in Oral and Maxillofacial Surgical Patients

For array of maxillofacial conditions, intubating maxillofacial surgical patients is a challenge for an anesthetist in our team. More often than not, our patients have multiple fractures with bleeding from nose and mouth along with limited mouth opening and doubtful condition of cervical spine [1, 2]. It is under these circumstances that a maxillofacial surgeon and an anesthetist find themselves quite often, sometimes in modern ORs (operating rooms) but mostly in substandard setups with not enough facilities for a safe oral or nasal direct laryngoscopy techniques. Maxillofacial surgical patients routinely need nasotracheal as well as oral intubations for procedures such as panfacial trauma, ankylosis of temporomandibular joint and oral submucous fibrosis.In recent times, technology has come to an aid in situations of difficult intubations, especially Videolaryngoscopy (Fiber optic laryngoscopy a gold standard in Videolaryngoscopy,VLS) [3]. Despite huge popularity of these techniques in modern setups, due to high equipment cost as well as steep learning curve these techniques still remain inaccessible to smaller resource deficient setups like government hospitals and remote peripheral locations in the country. The Anesthetist Society Scope or a TAScope, an indigenous innovation, as a modified and cost effective form of vidoelaryngoscope (total cost\ 8000 INR), portable and easy to adept, is developed by a fellow Anesthetist, which uses some very basic equipment, as described below (the pictures are attached) and a mobile phone [4]. TAScope is found useful in difficult intubations in panfacial trauma with concomitant cervical spine injury wherever minimal neck extension is desired, temporomandibular joint ankylosis and oral submucous fibrosis with mouth opening approximately 1.5 cm The authors have personal experience of this vidoelaryngoscope in cases of oral submucous fibrosis and temporomandibular ankylosis with mouth opening less than or equal to 1.5 cm,especially pediatric patients, when blind nasal intubation (rail road technique) failed and with tracheostomy as the only other remaining option. A regular TAScope comes with following parts and it works best through a mobile application.