2018 Volume 46 Issue 1 Pages 37-39
Nasotracheal tubes can be damaged during oral and maxillofacial surgery, because the nasotracheal tube is positioned close to the surgical field. We experienced a case of nasotracheal tube damage during a Le Fort type Ⅰosteotomy.
A 17-year-old woman who was classified as having ASA-PS 1 underwent a Le Fort type Ⅰosteotomy and sagittal split ramus osteotomy under general anesthesia. Nasotracheal intubation was performed via her right nostril. Sixty minutes after the start of the Le Fort type Ⅰosteotomy, the tidal volume decreased slightly and a leaking sound arising from the surgical site was detected. Although we tried to inflate the tube cuff, we could not supply air to the pilot balloon. Accordingly, gauze was tightly packed in the pharynx. The artificial ventilation was improved using pressure control ventilation with a positive end expiratory pressure. After extubation, a cut in the nasotracheal tube at a point 22 cm from the tube tip was observed. The depth of the tube damage was limited to the inflation-line.
The osteotomy line in a Le Fort type Ⅰosteotomy starts from the lateral margin of the piriform aperture and runs toward the posterior section of the maxillary tuberosity. Together with the nature of this surgical procedure, the site of tube damage in this case suggests that the nasotracheal tube was damaged during the osteotomy at the lateral margin of the piriform aperture. In addition, since the depth of the tube damage was limited to within the inflation-line, gauze packing in the pharynx compensated for the air leakage, and artificial ventilation was successfully maintained using pressure control ventilation with a positive end expiratory pressure.
