An Aid to Nasotracheal Intubation in Orthognathic Surgery

1993 ◽  
Vol 30 (3) ◽  
pp. 350-350 ◽  
Author(s):  
David W. Becker ◽  
Craig B. Bass ◽  
Vincent L. Williams
Author(s):  
Su Hyun Seo ◽  
Jun Mo Lee ◽  
Je Jin Lee ◽  
Eun Jin Ahn ◽  
Geun Joo Choi ◽  
...  

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.


2021 ◽  

Introduction: Nasotracheal intubation (NTI) is preferred for general anesthesia in maxillofacial surgery. However, NTI is often traumatic or even unsuccessful, particularly in patients with a narrow nasal pathway. In this case report, we describe a less traumatic NTI approach using maxillary downfracture of Le Fort I osteotomy. Case presentation: A 19-year-old woman was admitted with a skeletal Class III malocclusion and scheduled to undergo bimaxillary orthognathic surgery. A preoperative evaluation revealed no other medical history and abnormal laboratory findings. Preoperative computed tomography showed nasal septal deviation, concha bullosa, and turbinate hypertrophy. A nasal Ring-Adair-Elwyn endotracheal tube and a tube exchanger could not be inserted via NTI because of her narrow nasal cavity. An oral intubation was performed temporarily and surgery was started. After a maxillary downfracture was performed, which made the nasal cavity wider than before, NTI was successfully conducted without difficulty. The patient was ventilated without any problems, and the operation was continued. Postoperatively, the patient had no further complications and her vital parameters were all stable. Conclusions: This case report suggests that NTI after maxillary downfracture of Le Fort I osteotomy can be a good alternative that can be successfully performed with less trauma in patients undergoing orthognathic surgery who are preoperatively evaluated as having a narrow nasal cavity.


1993 ◽  
Vol 30 (3) ◽  
pp. 350-350 ◽  
Author(s):  
David W. Becker ◽  
Craig B. Bass ◽  
Vincent L. Williams

An atraumatic and reliable technique of nasal intubation in patients with previous pharyngoplasty or pharyngeal flap is presented. Using the tight and smooth fit of the fluted end of a red rubber catheter over the end of a nasotracheal tube is the technique described.


Author(s):  
Walace Daflon De Faria

A intubação submentoniana ou também conhecida como submento-oro-traqueal é uma técnica que conquistou diversos cirurgiões maxilofaciais ao longo dos anos, que por sua vez realizaram algumas pequenas alterações de acordo com seus conhecimentos anatômicos e vivência profissional. É um procedimento considerado seguro, fácil, rápido e de baixa morbidade. Por esse motivo é utilizada como alternativa para a traqueostomia, largamente utilizada e que possui maiores chances de complicações pós-operatórias. A intubação esta indicada para cirurgias de traumas panfaciais, em que há necessidade de manusear a oclusão do paciente no transoperatório, bem como em situações em que as técnicas consideradas mais convencionais, intubação orotraqueal e nasotraqueal, são contraindicadas. Além disso, atualmente pode ser indicada para cirurgia ortognática bimaxilar com rinoplastia simultânea, rinoplastia isolada e uma alternativa viável para pacientes portadores de fissura labial e/ou palatina. O objetivo deste trabalho é discutir as indicações e contraindicações deste método de intubação através de uma revisão de literatura, além de descrever os passos para sua execução. Palavras-Chaves: Trauma Maxilofacial; Intubação; Submento-Oro-TraquealABSTRACT The submental intubation or also known as submento-oro-traqueal is a technique that has conquered several maxillofacial surgeons over the years, in turn performed some small instances according to their anatomical knowledge and professional experience. It is a procedure considered safe, easy, fast and of low morbidity. For this reason it is used as an alternative to the widely used tracheostomy and has a higher chance of postoperative complications. Intubation is indicated for panacea trauma surgeries, in which there is a need to handle the occlusion of the patient in the intraoperative period, as well as in situations in which the techniques considered more conventional, orotracheal and nasotracheal intubation are contraindicated. In addition, it may currently be indicated for bimaxillary orthognathic surgery with simultaneous rhinoplasty, rhinoplasty alone and a viable alternative for patients with cleft lip and / or palate. The objective of this study is to discuss the indications and contraindications of this method of intubation through a literature review, in addition to describing the steps for its execution.  Key words: Maxillofacial Trauma; Intubation; Submento-Oro-Tracheal. 


2019 ◽  
Vol 55 ◽  
pp. 24-25
Author(s):  
Gloria Molins ◽  
Adaia Valls ◽  
Raquel Guijarro-Martínez ◽  
Jorge Masiá ◽  
Miriam de Nadal ◽  
...  

2019 ◽  
Vol 68 (4) ◽  
Author(s):  
Marco Migliorati ◽  
Sara Drago ◽  
Irene Schiavetti ◽  
Guglielmo Ramieri ◽  
Giovanni Gerbino ◽  
...  

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