We report a case of endotracheal tube damage that occurred during a maxillo-mandibular osteotomy and that was identified using a bronchofiberscope.
The patient was a 22-year-old man (height, 178 cm ; weight, 85 kg) who was scheduled to undergo a maxillo-mandibular osteotomy under general anesthesia for the treatment of two jaw deformities.
Anesthesia was induced with remifentanil and propofol. Rocuronium bromide was administered to facilitate muscle relaxation. Tracheal intubation using a Microcuff subglottic endotracheal tube (ID, 7.5 mm ; Halyard Healthcare Inc.) was performed via the left nasal cavity.
The anesthesia was maintained with air, oxygen, propofol, and remifentanil ; rocuronium was added as appropriate.
The surgery was initiated at the maxilla, and a maxillary transection was performed approximately 50 minutes later. The operator indicated that a ventilation gas leak had occurred after the maxillary transection, but examination using a bronchofiberscope did not reveal any abnormal findings. Because positive-pressure ventilation was possible and the ventilation was not problematic, we decided to resume the surgery. After the maxillary fixation was completed approximately 3.5 hours later and after a second bronchofiberscopic examination, we confirmed the inflow of blood into the tube and identified a tube laceration at around 4-5 cm from the nasal cavity entrance. We decided to conduct a tube exchange. We extubated the damaged tube and promptly performed oropharyngeal intubation. We carefully inserted a new tube into the nasal cavity and then extubated and promptly re-intubated the oral intubation tube.
After the surgery, the cause of the tube rupture was examined ; the tube was found to have been damaged by a bone chisel that had been used during the maxillary bone dissection. When endotracheal tube damage is suspected, confirmation of the inner surface using a bronchofiberscope is useful, and the early identification of such damage is important.
