Brasileiro Bernardo Ferreira, Van Sickels Joseph E
Kentucky Clinic.
Division of Oral and Maxillofacial Surgery, College of Dentistry, University of Kentucky, Lexington, KY.
J Craniofac Surg. 2019 Sep;30(6):e533-e535. doi: 10.1097/SCS.0000000000005481.
Nasotracheal intubation is routinely used in patients undergoing oral and maxillofacial surgery when intermaxillary fixation is needed either intraoperatively or postoperative. Various complications can occur such as epistaxis, turbinectomy, retropharyngeal dissection, tympanites, and nasal alar pressure sores or necrosis, especially when there is a prolonged nasotracheal intubation. The first report of a nasal alar necrosis after prolonged nasotracheal intubation was published by Hatcher et al in 1968. Since then several reports of skin necrosis of the nasal alar region have been published and attributed to a prolonged operation or the technique used in tube placement. Pressure ulcers are a localized damage to the skin and underlying soft tissue and usually appear immediately after the procedure. They start with nonblanchable erythematous intact skin and can evolve to partial thickness loss of skin with exposed dermis and scab formation during the healing process. They may be painful and can cause a cosmetic problem for patients. The literature has several studies of nasal alar necrosis after nasotracheal intubation for head and neck reconstructive surgery, but there is no description of this complication after orthognathic surgery. This paper describes the occurrence of skin nasal alar necrosis following a bimaxillary jaw correction and highlights recommendations for its management and prevention.
当口腔颌面外科手术患者在术中或术后需要进行颌间固定时，通常会采用经鼻气管插管。可能会出现各种并发症，如鼻出血、鼻甲切除术、咽后剥离、鼓胀以及鼻翼压迫性溃疡或坏死，尤其是在经鼻气管插管时间延长时。1968年，哈彻等人发表了关于长时间经鼻气管插管后鼻翼坏死的首例报告。从那时起，已有多篇关于鼻翼区域皮肤坏死的报告发表，并归因于手术时间延长或插管放置技术。压疮是皮肤和皮下软组织的局部损伤，通常在手术后立即出现。起初是皮肤完整但不可压褪色的红斑，在愈合过程中可能发展为皮肤部分厚度缺失，伴有真皮暴露和结痂形成。它们可能会疼痛，并且会给患者带来美容问题。文献中有多项关于头颈部重建手术经鼻气管插管后鼻翼坏死的研究，但没有关于正颌手术后这种并发症的描述。本文描述了双颌矫正术后鼻翼皮肤坏死的发生情况，并重点介绍了其处理和预防建议。
