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We describe a do-it-yourself method of making a bite guard, using pairs of Foley catheters and surgical gloves to prevent tongue, lip, and other injuries during the monitoring of transcranially elicited motor evoked potential. We have used it in five cases, and have found that the hack is particularly cost-effective and reliable. We describe the te...
Context in source publication
Context 1
... we describe an easy method of making disposable bite guards using commonly available materials, to prevent tongue, lip, and teeth injuries. The only materials required are two 16F (or 18F) Foley catheters, and a pair of surgical gloves, as shown in Figure 1. The first step involves cutting out two fingers of the surgical gloves along the dotted line, so that there are two free and loose flaps for each, as illustrated in Figure 2. ...
Citations
... Especially, in spinal tumor surgery, bite injury and facial pressure ulcers are likely to occur because the operation time tends to be long and transcranial stimulation is frequently applied to check motor function. In the case of prolonged surgery, it is necessary to pause the procedure at regular intervals to decompress the face and check the wound [5]. ...
... The bite block should be large enough to prevent the teeth from becoming close to the tongue and is secured properly to minimize the chance of shifting [2]. And the bite blocks should be also kept between the molar teeth on both sides, keeping only one in the middle is a risk [5]. Furthermore, a mouthpiece is also considered effective in preventing bite injury [11]. ...
Transcranial motor evoked potential (MEP) is a common method in spinal surgery but requires strong electrical stimulation. Frequent transcranial stimulations can cause bite injury. In addition, a facial pressure ulcer is a problem in spinal surgery requiring prone positioning. We present a case of bite injury and facial pressure ulcer in prolonged lumbar tumor surgery with repeated transcranial stimulations. A 74-year-old woman developed left lower limb and low back pain. MRI revealed an intradural extramedullary tumor at L1. We performed tumor resection surgery. A silicon bite block was used, and the patient's head was placed on a sponge headrest. The tumor was a schwannoma originating from the nerve root that innervated the left anal sphincter. Intracapsular resection was performed while referring to the frequent transcranial MEP monitoring. The left lower limb and low back pain improved after surgery; however, lip injury and facial skin ulcer occurred. The face showed marked swelling and was painful, so oral intake was difficult for a week. Wound healing was obtained three months postoperatively, but hypoesthesia remained. When using MEP in prolonged spine surgery with a headrest, it is necessary to pay attention to both bite injury and facial pressure ulcer. Intraoperative assessment of the face, number of transcranial stimulations, types of a bite block, and headrest may be important.
... Bilateral bite blocks using different materials (rolled gauze/gauze around the plastic syringe/using foley catheter and the glove/ silicone bite block) between the upper and lower molar teeth can also be used to prevent bite injuries. 3 After placing the appropriate size bite block, checking whether the intraoral structures are free is mandatory. Proper placement of bite block should be added as a part of the surgical checklist in patients undergoing Tc-MEP monitoring to improve patient safety. ...
