Recurrent nerve palsy after general anesthesia is a rare complication with an incidence of 0.1％ or less. Here, we report two cases of diagnosed unilateral recurrent nerve palsy after general anesthesia for orthognathic surgery.
Case 1 was a 32-year-old female (155 cm, 63 kg) scheduled to undergo a sagittal split ramus osteotomy (SSRO). Nasotracheal intubation was performed using a Portex Cuffed Maxillofacial Nasal Directional Endotracheal Tube® (∅6.5 mm) and a McGRATH MAC Video laryngoscope®. The patient’s head was retroflexed 40° for 1 hour and 56 min. After the general anesthesia, the patient became dysphonic and required 3 months to recover vocalization.
Case 2 was a 38-year-old female (159 cm, 57 kg) scheduled to undergo an SSRO and Le FortⅠosteotomy. Nasotracheal intubation was performed using the same tube as that used in Case 1, and the patient’s head was retroflexed 40° for 4 hours and 51 min. The endotracheal cuff pressure was monitored using a disposable pressure transducer connected to the pilot balloon during the operation. The cuff pressure changed according to surgical manipulation, but the mean value was 28.4±3.2 cmH2O. After the general anesthesia, the patient became dysphonic and required 48 days to recover vocalization.
During orthognathic surgery, the nasotracheal tube cuff can compress the recurrent nerve inside the thyroid cartilage. Consequently, nerve palsy can occur even if the operation time is relatively short or the cuff pressure is appropriate. Repeated tracheal tube cuff pressure changes during orthognathic surgery may increase the risk of developing recurrent nerve palsy.
