Technical note
Iatrogenic damage to the endotracheal tube is a rare and potentially life-threating complication of Oral & Maxillofacial surgery. Proximity of the endotracheal tube to the surgical field poses a legitimate threat of inadvertent airway compromise [ ]. We describe the intraoperative management and postoperative trouble-shooting in the case of endotracheal tube damage during a Le Fort I osteotomy.
A twenty year old male underwent a Le Fort I osteotomy for management of a class III skeletal base, secondary to maxillary hypoplasia. The patient was anaesthetised uneventfully via nasotracheal intubation. Following pterygomaxillary disjunction, the mucosa of the nasal floor was dissected and the cartilaginous caudal septum was refined using a scalpel. An alar cinch technique was then completed to minimise lateralisation of the nasal base. Soon thereafter, the patient began desaturating secondary to an air leak of unknown origin. As the source of the air leak could not be identified intra-operatively, the working consensus was that the nasotracheal tubing was inadvertently damaged during the septoplasty. This was tactfully managed by our anaesthetic colleagues by slowly and continuously reinflating the endotracheal cuff using a fifty millilitre syringe. The patient’s ventilation remained stable and the osteotomy was completed. The patient was then extubated uneventfully. Following the operation, the endotracheal tube was examined for signs of potential damage. There were no perforations evident in the tubing. In a model experiment, to identify the source of the prior air leak, the nasotracheal tube was submerged in a body of water ( Figs. 1–3 ). When the cuff was inflated, air bubbles were seen emanating from the tubing. This confirmed the presence of a discrete tear in the endotracheal tube ( Fig. 3 ).
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