Journal of Dental Anesthesia and Pain Medicine

  • 제16권4호
  • /
  • Pages.309-312
  • /
  • 2016
  • /
  • 2383-9309(pISSN)
  • /
  • 2383-9317(eISSN)
대한치과마취과학회 (The Korean Dental Society of Anesthsiology)
권호 표지
DOI QR코드

DOI QR Code

Pharyngeal flap damage caused by nasotracheal intubation in a patient who underwent palatoplasty and pharyngoplasty

  • Oh, Jong-Shik (Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University) ;
  • Choi, Hong-Seok (Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University) ;
  • Kim, Eun-Jung (Department of Dental Anesthesia and Pain Medicine, Pusan National University Dental Hospital) ;
  • Kim, Cheul-Hong (Department of Dental Anesthesia and Pain Medicine, Pusan National University Dental Hospital) ;
  • Yoon, Ji-Uk (Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital) ;
  • Yoon, Ji-Young (Department of Dental Anesthesia and Pain Medicine, Pusan National University Dental Hospital)
  • 투고 : 2016.12.16
  • 심사 : 2016.12.19
  • 발행 : 2016.12.31
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Patients with cleft lip and palate (CLP) must undergo corrective surgeries during infancy and early childhood. Many patients with CLP undergo orthognathic surgery during their childhood for correction of skeletal asymmetries or pharyngoplasty with a pharyngeal flap to improve the quality of speech and velopharyngeal function. During orthognathic surgeries, nasotracheal intubation is performed under general anesthesia. In our case report, the patient had undergone palatoplasty and pharygoplasty previously. During the orthognathic surgery, a flexible fiberoptic bronchoscope-guided nasotracheal tube was inserted through the pharyngeal flap ostium; however, active bleeding occurred in the nasopharynx. Bleeding occurred because the flap was torn. After achieving hemostasis, the surgery was completed successfully. Thus, if a patient may show the potential for velopharyngeal port obstruction, nasotracheal intubation should be performed with utmost care.

키워드

참고문헌

  1. Kopp VJ, Rosenfeld MJ, Turvey TA. Nasotracheal intubation in the presence of pharyngeal flap in children and adults. Anesthesiology 1995; 82: 1063-4. https://doi.org/10.1097/00000542-199504000-00029
  2. Hee HI, Conskunfirat ND, Wong SY, Chen C. Airway management in a patient with a cleft palate after pharyngoplasty: a case report. Can J Anesth 2003; 50: 721-24. https://doi.org/10.1007/BF03018717
  3. Panula K, Lorius BB, Pospisil OA. The need for orthognathic surgery in patients born with complete cleft palate or complete unilateral cleft lip and palate. Oral Surg Oral Diag 1993; 4: 23-8.
  4. Davies. D. Cleft lip and palate: British Medical Journal 1985; 290: 625. https://doi.org/10.1136/bmj.290.6468.625
  5. Bell DN, Macintyre DR, Ross JW, Pigott RW, Weller RM. Pharyngoplasty: a hazard for nasotracheal intubation. Br J Oral Maxillofac Surg 1986; 24: 212-6. https://doi.org/10.1016/0266-4356(86)90077-X
  6. Robin NH, Baty H, Franklin J, Guyton FC, Mann J, Woolley AL, et al. The multidisciplinary evaluation and management of cleft lip and palate. South Med J 2006; 99: 1111-20. https://doi.org/10.1097/01.smj.0000209093.78617.3a
  7. Piepho T, Thierbach A, Werner C. Nasotracheal intubation: look before you leap. Br J Anaesth 2005; 94: 859-60. https://doi.org/10.1093/bja/aei146
  8. Enk D, Palmes AM, Van Aken H, Westphal M. Nasotracheal intubation: a simple and effective technique to reduce nasopharyngeal trauma and tube contamination. Anesth Analg 2002; 95: 1432-6. https://doi.org/10.1097/00000539-200211000-00061
  9. Kihara S, Komatsuzaki T, Brimacombe JR, Yaguchi Y, Taguchi N, Watanabe S. A silicone-based wire reinforced tracheal tube with a hemispherical bevel reduces nasal morbidity for nasotracheal intubation. Anesth Analg 2003; 97: 1488-91.
  10. Hansen M, Poulsen MR, Bendixen DK, Hartmann-Andersen F. Incidence of sinusitis in patients with nasotracheal intubation. Br J Anaesth 1988; 61: 231-2. https://doi.org/10.1093/bja/61.2.231
  11. Oncag O, Cokmez B, Aydemir S, Balcioglu T. Investigation of bacteremia following nasotracheal intubation. Paediatr Anaesth 2005; 15: 194-8. https://doi.org/10.1111/j.1460-9592.2005.01503.x
  12. Ng SY, Yew WS. Nasotracheal tube occlusion from adenoid trauma. Anaesth Intensive Care 2006; 34: 829-30.
  13. Krebs MJ, Sakai T. Retropharyngeal dissection during nasotracheal intubation: a rare complication and its Management. J Clin Anesth 2008; 20: 218-21. https://doi.org/10.1016/j.jclinane.2007.09.021
  14. Kim YC, Lee SH, Noh GJ, Cho SY, Yeom JH, Shin WJ et al. Thermosoftening Treatment of the nasotracheal tube before intubation can reduce epistaxis and nasal damage. Anesth Analg 2000; 91: 698-701. https://doi.org/10.1213/00000539-200009000-00038