Anatomic

Limited mouth opening / trismus

Before / During / After / Pitfalls

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.