Anesth Pain Med.  2021 Oct;16(4):398-402. 10.17085/apm.21015.

Repeated endotracheal tube cuff tears during nasotracheal intubation due to nasal cavity orthodontic micro-implant - A case report -

Affiliations
  • 1Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul, Korea

Abstract

Background
Nasotracheal intubation is generally performed for intraoral surgery. Case: A 34-year-old female patient who underwent orthognathic surgery exhibited repeated endotracheal tube cuff tears during nasotracheal intubation. After intubation, leaks developed, and torn endotracheal cuff was observed in the removed endotracheal tube. Subsequently, re-intubation through the same nasal cavity was performed immediately, but leakage from the torn endotracheal tube cuff was re-observed. A leakage test of the extubated tube revealed air bubbles and leaks near the tube cuff due to the tear. Nasotracheal intubation was performed through the other nasal cavity, and there were no leakage findings or abnormalities. During the course of the surgery, the surgeon noticed that the orthodontic micro-implant deposited in the mid-tube cavity was exposed to the nasal cavity.
Conclusions
We aimed to emphasize caution and discuss the possibility that orthodontic micro-implants that are not confirmed during preoperative evaluation may cause repeated endotracheal tube cuff tears.

Keyword

Cuff leakage; Dental implants; Intratracheal intubation; Nasotracheal intubation; Orthognathic surgery

Figure

  • Fig. 1. Preoperative skull radiography. Preoperative skull radiography showed no remarkable findings.

  • Fig. 2. Image of the micro-implant protruding from the single-stage ceiling in the patient. The micro-implant screw was fixed at a position 3 mm from the central line to the right from the single-stage ceiling. Tip of yellow arrow represent the micro-implant screw.

  • Fig. 3. Postoperative skull radiography. Postoperative skull radiography showed a screw protruding into the right nasal cavity, which was not observed on preoperative radiography. Tip of yellow arrow represent the micro-implant screw.

  • Fig. 4. Postoperative computed tomography of the skull. On computed tomography of the skull performed after the surgery, the metallic material in the right nasal cavity was identified. Tip of yellow arrow represent the micro-implant screw.


Reference

1. Stauffer JL, Olson DE, Petty TL. Complications and consequences of endotracheal intubation and tracheotomy. A prospective study of 150 critically ill adult patients. Am J Med. 1981; 70:65–76.
2. Zwillich CW, Pierson DJ, Creagh CE, Sutton FD, Schatz E, Petty TL. Complications of assisted ventilation. A prospective study of 354 consecutive episodes. Am J Med. 1974; 57:161–70.
3. El-Orbany M, Salem MR. Endotracheal tube cuff leaks: causes, consequences, and management. Anesth Analg. 2013; 117:428–34.
4. Chen CH, Chang CS, Hsieh CH, Tseng YC, Shen YS, Huang IY, et al. The use of microimplants in orthodontic anchorage. J Oral Maxillofac Surg. 2006; 64:1209–13.
5. Hall CE, Shutt LE. Nasotracheal intubation for head and neck surgery. Anaesthesia. 2003; 58:249–56.
6. Prasanna D, Bhat S. Nasotracheal intubation: an overview. J Maxillofac Oral Surg. 2014; 13:366–72.
7. Kim DR, Jung YH, Kang H, Oh JI, Park Y. Accidental middle turbinectomy by nasotracheal intubation −a case report−. Anesth Pain Med. 2016; 11:217–9.
8. Nakamura S, Watanabe T, Hiroi E, Sasaki T, Matsumoto N, Hori T. [Cuff damage during naso-tracheal intubation for general anesthesia in oral surgery]. Masui. 1997; 46:1508–14. Japanese.
9. Scamman FL, Babin RW. An unusual complication of nasotracheal intubation. Anesthesiology. 1983; 59:352–3.
10. Ahmed-Nusrath A, Tong JL, Smith JE. Pathways through the nose for nasal intubation: a comparison of three endotracheal tubes. Br J Anaesth. 2008; 100:269–74.
11. Sahin-Yilmaz A, Naclerio RM. Anatomy and physiology of the upper airway. Proc Am Thorac Soc. 2011; 8:31–9.
12. Williamson R. Nasotracheal intubation for head and neck surgery. Anaesthesia. 2003; 58:1129–30; author reply 1130-1. .
13. Abraham ST, Paul MMC. Micro implants for orthodontic anchorage: a review of complications and management. J Dent Implant. 2013; 3:165–7.
14. Nojima K, Komatsu K, Isshiki Y, Ikumoto H, Hanai J, Saito C. The use of an osseointegrated implant for orthodontic anchorage to a Class II Div 1 malocclusion. Bull Tokyo Dent Coll. 2001; 42:177–83.
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