Anesth Pain Med.  2021 Oct;16(4):398-402. 10.17085/apm.21015.

Repeated endotracheal tube cuff tears during nasotracheal intubation due to nasal cavity orthodontic micro-implant - A case report -

• Seo SH
• Lee JM
• Lee JJ
• Ahn EJ
• Choi GJ
• Kang H

• KMID: 2524454
• DOI: http://doi.org/10.17085/apm.21015

Abstract

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.

Keyword

Cuff leakage; Dental implants; Intratracheal intubation; Nasotracheal intubation; Orthognathic surgery

Figure

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  Fig. 1. Preoperative skull radiography. Preoperative skull radiography showed no remarkable findings.

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  Fig. 2. Image of the micro-implant protruding from the single-stage ceiling in the patient. The micro-implant screw was fixed at a position 3 mm from the central line to the right from the single-stage ceiling. Tip of yellow arrow represent the micro-implant screw.

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  Fig. 3. Postoperative skull radiography. Postoperative skull radiography showed a screw protruding into the right nasal cavity, which was not observed on preoperative radiography. Tip of yellow arrow represent the micro-implant screw.

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  Fig. 4. Postoperative computed tomography of the skull. On computed tomography of the skull performed after the surgery, the metallic material in the right nasal cavity was identified. Tip of yellow arrow represent the micro-implant screw.

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