Education  |   July 2019
Oropharynx in Scleroderma
Author Notes
  • From the Department of Anesthesiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
  • Address correspondence to Dr. Foote: footej@uthscsa.edu
Article Information
Education / Images in Anesthesiology / Gastrointestinal and Hepatic Systems / Respiratory System
Education   |   July 2019
Oropharynx in Scleroderma
Anesthesiology 7 2019, Vol.131, 149. doi:10.1097/ALN.0000000000002658
Anesthesiology 7 2019, Vol.131, 149. doi:10.1097/ALN.0000000000002658
These photographs show a patient with advanced scleroderma who presented for emergent abdominal surgery. Image A demonstrates a maximal oral opening with an interincisor distance of approximately 1 cm. The restricted oral opening necessitated fiberoptic nasotracheal intubation to safely secure the airway. Due to the patient’s taut and fibrotic skin, with resulting upper extremity deformity (image B), insertion of an internal jugular venous catheter was also required.
Scleroderma is characterized by autoimmune-mediated inflammation, vascular injury, and excessive fibrosis of skin and internal organs.1  Autoantibodies and inflammatory cascades lead to the obliteration of small arteries and general endothelial injury, resulting in widespread capillary loss and leakage of serum proteins into the interstitial spaces. Tissue edema and lymphatic obstruction progress to severe fibrosis and organ sclerosis.2