To the Editor:-A 17-yr-old girl was scheduled for an outpatient diagnostic laparoscopy during general anesthesia. During the preoperative anesthetic evaluation, it was found the patient's tongue was pierced with a silver dumbbell-shaped piece of jewelry through the middle of the anterior one third of her tongue. This piercing had been done less than 1 month before this surgical procedure, and the patient did not want to remove the jewelry because it would be difficult to reinsert.
Anesthesia was performed with propofol, fentanyl, nitrous oxide, and oxygen. No difficulty with mask ventilation was encountered. Vecuronium was given to facilitate laryngoscopy. Direct laryngoscopy and visualization of the vocal cords was accomplished with a Macintosh #3 blade, and the patient was orally intubated with a 6.5 cuffed endotracheal tube. After confirmation of correct endotracheal tube placement, the tube was placed to the right side of the tongue to avoid direct compression of the ring in the tongue and then secured. The presence of the tongue jewelry did not interfere with laryngoscopy or placement of the endotracheal tube, and there was no evidence of trauma to the tongue or dentition. Before discharge home that day, the patient's oral cavity was reexamined, and no evidence suggesting trauma from the intubation was seen. The patient had no complaints of pain, soreness, or swelling of the tongue. It appears direct laryngoscopy and oral intubation can be accomplished safely in patients with tongue jewelry as long as one is cognizant of its presence and care is exercised during the procedure.
Tanya L. Oyos, M.D.
Associate Professor; Department of Anesthesia; The University of Iowa Hospitals and Clinics; 6th Floor JCP; 200 Hawkins Drive; Iowa City, Iowa 52242
(Accepted for publication March 12, 1997.)