Anesth Pain Med.  2018 Jul;13(3):341-345. 10.17085/apm.2018.13.3.341.

Successful application of high-flow nasal cannula in a patient with postoperative respiratory disturbance after bilateral sagittal split ramus osteotomy surgery: A case report

• Jung KT
• Ji IG
• Kim SH

• KMID: 2436046
• DOI: http://doi.org/10.17085/apm.2018.13.3.341

Abstract

Bilateral sagittal split ramus osteotomy (BSSRO) is generally indicated for mandibular setback, to improve occlusion, masticatory function, and aesthetics by altering the mandibular position. However, BSSRO narrows the pharyngeal airway and increases airway resistance, resulting in postoperative respiratory disturbances during emergence from anesthesia. Oxygen delivery system via high-flow nasal cannula (HFNC) has been known to improve airway patency and oxygenation via low-level positive pressure as well as reduce the respiratory load. We report a case of postoperative respiratory disturbance, following a large mandibular setback, despite nasotracheal extubation in the fully awake patient. Respiratory disturbance was successfully controlled after oxygen delivery via HFNC until self-respiration was completely restored. Therefore, the use of HFNC may facilitate the control of postoperative respiratory disturbances induced by anatomical changes in upper airway after BSSRO surgery.

Keyword

Adult respiratory distress syndrome; Dyspnea; High-flow nasal cannula; Orthognathic surgical procedures; Oxygen inhalation therapy

MeSH Terms

Airway Resistance
Anesthesia
Catheters*
Dyspnea
Esthetics
Humans
Orthognathic Surgical Procedures
Osteotomy, Sagittal Split Ramus*
Oxygen
Oxygen Inhalation Therapy
Respiratory Distress Syndrome, Adult
Oxygen

Figure

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  Fig. 1 Dental X-ray shows anatomical changes in the upper airway before (A) and after (B) bilateral sagittal split ramus osteotomy surgery. Cephalometric analysis of the posterior airway space (PAS) in the mandibular plane shows a decreased diameter (9.8 mm) compared with the preoperative diameter (15.4 mm).

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