J Dent Anesth Pain Med.  2016 Dec;16(4):309-312. 10.17245/jdapm.2016.16.4.309.

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

• Oh JS
• Choi HS
• Kim EJ
• Kim CH
• Yoon JU
• Yoon JY

• KMID: 2366160
• DOI: http://doi.org/10.17245/jdapm.2016.16.4.309

Abstract

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.

Keyword

Complication; Flap; Intubation; Tears

MeSH Terms

Anesthesia, General
Cleft Lip
Hemorrhage
Hemostasis
Humans
Intubation*
Nasopharynx
Orthognathic Surgery
Palate
Tears

Figure

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  Fig. 1 Nasopharyngoscopic view of velopharyngeal port and flap.

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  Fig. 2 Postoperative nasendoscopic examnination shows intact pharyngeal flap (arrow).

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