Abstract
In oral and maxillofacial surgery, the airway is often adjacent to the surgical field, increasing the risk of tracheal tube damage. We report a case of intraoperative endotracheal tube injury caused by an ultrasonic cutting instrument during a partial maxillectomy and successful reintubation using a video laryngoscope. An 81-year-old woman underwent a partial resection of the left maxilla under general anesthesia for the treatment of a maxillary gingival carcinoma. Nasal intubation was performed using a video laryngoscope. During surgery, a ventilator alarm indicated a reduced minute ventilation. On inspection, damage to the nasotracheal tube was identified. Reintubation under video laryngoscopic guidance was promptly and safely performed without oxygen desaturation. This case highlights the need for careful preoperative planning, including the selection of an appropriate intubation route and preparations for possible reintubation, especially in surgeries involving shared surgical and airway fields. In the present case, the progression of the tumor had brought the nasotracheal tube into the operative field. The oral surgeon assumed that the ultrasonic cutting instruments, which are commonly used for cutting soft tissue, would not damage the soft tracheal tube. However, polyvinyl chloride (PVC), a standard material used in tracheal tubes, can absorb ultrasonic energy and is susceptible to both thermal and mechanical injury. Preventing such incidents requires thorough interdisciplinary communication and awareness of equipment-specific risks, particularly when energy-based surgical tools are used near airway devices.
