2018 Volume 46 Issue 1 Pages 25-27
Cuff damage during nasotracheal intubation is not uncommon. We treated a case with cuff damage caused by a fixation screw during nasotracheal intubation.
A 22-year-old woman (height, 158 cm ; weight, 52 kg) was scheduled to undergo a plate removal and genioplasty after a Le Fort Ⅰ osteotomy and bilateral sagittal split ramus osteotomy.
After the induction of anesthesia, a 6.5-ID tracheal tube (ParkerTM) was introduced via the right nostril and tracheal intubation was easily achieved. However, the cuff could not be filled with air, and an air leak was discovered during artificial ventilation. After extubation, the cuff was found to have been torn and a scratch was found on the tube. A second attempt through the right nostril using a tracheal tube of the same size produced the same result. Subsequently, a 6.5-ID tracheal tube (MallinckrodtTM) was introduced via the left nostril. As a result, the third nasotracheal intubation was successful, with no damage to the cuff occurring.
A computed tomography examination of the head obtained before surgery showed that the tip of a fixation screw had penetrated the right nasal cavity. The cuff damage was suspected to have been caused by the fixation screw, since the locations of the cuff damage and the screw coincided.
When nasotracheal intubation is performed, it is important to check not only the narrowness of the nasal cavity and the nasal septal spur, but also the position of fixation screws remaining after surgery for jaw deformities using a computed tomography examination of the maxillofacial region.
