Tracheal scoliosis in Rheumatoid Arthritis !!

-30-50% of rheumatoid arthritis patients have significant cervical spine involvement (autopsy studies).

-Airway management may be difficult owing to cervical subluxation, seen in 43 to 85% of such patients, with or without cervical restriction.

-There may be TMJ ankylosis, narrowing of the glottic aperture, limited mouth opening, and micrognathism.

-Cricoarytenoid arthritis may lead to airway obstruction during induction or post-extubation.

-Chronic cricoarytenoid arthritis may be mistaken for asthma or chronic bronchitis, with symptoms of hoarsness, dyspnea or stridor, and it may be the sole manifestation of the disease.

- "Tracheal scoliosis" has been described in patients with rheumatoid arthritis consisting of the anatomical triad of tracheal deviation, laryngeal rotation, and anterior angulation.

Guerra LG, Lau KY, Marwah R. Upper airway obstruction as the sole manifestation of rheumatoid arthritis. J Rheumatol 1992; 19: 974-976, 1992.

Gurley JP, Bell GR. The surgical management of patients with rheumatoid cervical spine disease. Rheum Dis Clin North Am 23:317-332, 1997.

Kohjitani A, Miyawaki T, Kasuya K, Mishima K, Sugahara T, Shimada M. Anesthetic management for advanced rheumatoid arthritis patients with acquired micrognathia undergoing temporomandibular joint replacement. J Oral Maxillofac Surg 60:559-566, 2002

Wattenmaker I, Concepcion M, Hibberd P, Lipson S. Upper-airway obstruction and perioperative management of the airway in patients managed with posterior operations on the cervical spine for rheumatoid arthritis. J Bone Joint Surg Am 76:360-365, 1994.

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