bag-mask ventilation in an edentulous patient

Q: Describe few tricks to have proper mask seal in edentulous patients during bag-mask ventilation?

Answer: Edentulous patients offer a challenge to have proper mask seal during bag-mask ventilation. Few tricks which may help:

1. Reinsert the false teeth.

2. Expand cheeks with 4 x 4 gauze.

3. Lower lip placement of mask : The caudad end of the face mask is positioned between the lower lip and the alveolar ridge.

4. Perform two-handed thenar eminence method: The index fingers lift the soft tissue of the cheeks against the rim of the facemask, while the remaining three fingers pull the jaw upward.

#procedures

References: 

1. Conlon NP, Sullivan RP, Herbison PG, et al. The effect of leaving dentures in place on bag-mask ventilation at induction of general anesthesia. Anesth Analg 2007; 105:370. 

2. Racine SX, Solis A, Hamou NA, et al. Face mask ventilation in edentulous patients: a comparison of mandibular groove and lower lip placement. Anesthesiology 2010; 112:1190. 

3. Jain D, Sahni N, Goel N, et al. The C-E versus modified V-E hand positions for holding a face mask when ventilating an edentulous patient: A randomised crossover trial. Eur J Anaesthesiol 2021; 38:1194.