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Simplified Technique to Change the Endotracheal Tube From Nasal to Oral to Facilitate Orthognathic and Nasal Surgery

2006; Elsevier BV; Volume: 64; Issue: 8 Linguagem: Inglês

10.1016/j.joms.2006.03.045

1531-5053

Toshitaka Muto, Kazuki Akizuki, Larry M. Wolford,

Head and Neck Surgical Oncology

The surgical correction of patients with dentofacial deformities usually requires naso-endotracheal intubation to facilitate orthognathic surgery. However, the presence of the ventilating tube in the nose can interfere with the concomitant performance and accuracy of surgical procedures on the nose such as rhinoplasty, 1 Cottrell D.A. Wolford L.M. Factors influencing combined orthognathic and rhinoplasty surgery. Int J Adult Orthod Orthognath Surg. 1993; 8: 26 Google Scholar transnasal approach for septoplasty or turbinectomies, and placement of the alar base cinch suture. 2 Guymon M. Crosby D. Wolford L.M. The alar base cinch suture to control nasal width in maxillary osteotomies. Int J Adult Orthod Orthognath Surg. 1988; 3: 89 PubMed Google Scholar , 3 Collins P.C. Epker B.N. The alar base cinch A technique for prevention of alar base flaring secondary to maxillary surgery. Oral Surg Oral Med Oral Pathol. 1982; 53: 549 Abstract Full Text PDF PubMed Scopus (78) Google Scholar These nasal procedures when done concomitantly are usually carried out after completion of the orthognathic procedures. To facilitate the nasal surgery the endotracheal tube can be switched from a nasal tube to an oral tube. Traditionally, the anesthesiologist will remove the naso-endotracheal tube and replace it with an oro-endotracheal tube. 1 Cottrell D.A. Wolford L.M. Factors influencing combined orthognathic and rhinoplasty surgery. Int J Adult Orthod Orthognath Surg. 1993; 8: 26 Google Scholar This usually requires the use of a laryngoscope with potential significant pressure applied to the mandible or maxilla that could cause damage to the osteotomy sites and displacement of the jaw structures. This approach will also expose the patient to possible pulmonary aspiration of blood and fluids. It became necessary to develop a simple and safe technique to switch from a naso-endotracheal tube to an oro-endotracheal tube that would not jeopardize the stability of the orthognathic surgery or compromise the airway.