A novel monocanalicular silicone intubation technique for canalicular laceration repair

Dacryocystorhinostomy (DCR) is the ‘gold standard’ treatment for nasolacrimal duct obstruction (NLDO). However, despite its recent technical advancements, complications are possible. Herein, to the best of our knowledge, we present the first reported case of delayed unilateral pneumocephalus after bilateral endoscopic DCR. An 85-year-old man with bilateral NLDO underwent endoscopic DCR with silicone intubation. After 1 month, he became lethargic and was admitted to emergency room. Brain CT demonstrated left pneumocephalus and a suspected microfistula in left orbital wall. Intravenous antibiotic therapy was started, and cerebrospinal fluid studies showed no evidence of meningitis. After 13 days of antibiotic treatment, his mental state recovered with no signs of pneumocephalus. Although DCR has high success rate and is relatively safe, surgeons should be aware of the risk, although low, of pneumocephalus, especially in elderly patients who are vulnerable to fractures and who exhibit headache or mental status changes after endoscopic DCR.

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Effect of Short-Duration Silicone Intubation in Congenital Nasolacrimal Duct Obstruction

Ophthalmic Plastic and Reconstructive Surgery ◽

10.1097/iop.0b013e31817113f5 ◽

2008 ◽

Vol 24 (3) ◽

pp. 167-171 ◽

Cited By ~ 24

Author(s):

Neal J. Peterson ◽

R Grey Weaver ◽

R Patrick Yeatts

Keyword(s):

Short Duration ◽

Nasolacrimal Duct ◽

Nasolacrimal Duct Obstruction ◽

Congenital Nasolacrimal Duct Obstruction ◽

Duct Obstruction ◽

Silicone Intubation

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Comparison among the Intubation Techniques Employed in the Course of Management of Pan-Facial Trauma

10.37191/mapsci-jdr-1(1)-009 ◽

2021 ◽

Author(s):

Aravindh RJ

Keyword(s):

General Anesthesia ◽

Nasotracheal Intubation ◽

Functional Results ◽

Orotracheal Intubation ◽

Facial Trauma ◽

Minimal Risk ◽

Intermaxillary Fixation ◽

Intubation Technique ◽

Submental Intubation ◽

Intraoperative Period

Objective: To find the best method of intubation in patients sustaining pan-facial trauma by comparing the pros and cons of each technique. Materials and methods: Three different types of intubation techniques (nasotracheal intubation, orotracheal intubation, and sub-mental intubation) were considered in this study. The study population involves 9 patients who have undergone treatment for pan-facial trauma under general anesthesia (3 patients per technique) and the variables of clinical outcome of each group were recorded. Results: Nasal intubation is the most common and safest method of intubation. However, it can’t be used in some types of pan-facial trauma. In cases like these, oral intubation is not preferred. As it severely compromises maxillofacial repair because of interference with the placement of intermaxillary fixation [3](IMF), which is used to establish the patient s occlusion in the intraoperative period. Submental intubation is an alternative with minimal risk to tracheostomy when orotracheal or nasotracheal intubation is not appropriate. The submental intubation technique gave an uninterrupted surgical field, unobstructed airway, ease of gaining occlusion in general anesthesia, less intraoperative and postoperative complications and it overcomes the disadvantages of both nasotracheal and orotracheal intubation. Conclusion: Preferred techniques of securing an airway are orotracheal, nasotracheal intubation. However these techniques may not always be applicable, thus a trauma surgeon-anesthetist team should always have alternative techniques in their armamentarium which secures the patient's airways without interfering with occlusion, to gain at most postoperative esthetic and functional results.

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