Boxer's mouthguard to facilitate motor evoked potential monitoring during cervical intramedullary tumour excision: Protect and prevent rather than repair and repent!

Abstract

Intraoperative motor evoked potentials are being increasingly used in surgeries for the removal of spinal tumours. However, this useful monitoring is accompanied by risks such as bite injury to the tongue and oral mucosal soft tissues due to clenching of the teeth and jaws as the patient may not be completely under the effect of neuromuscular blocking agents, resulting in bleeding in the oropharynx. To prevent these complications, we conceptualised and utilised a boxer's mouthguard as a preventive protection during cervical intramedullary tumour excision surgery. Such mouthguards are routinely used in contact sports such as boxing but their clinical application in neuroanaesthesia has not been described. This use is a novel, economical, convenient, standardised and easy way of bite protection and preventing intraoperative tongue, soft-tissue injuries and airway complications.