Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School and Chonnam National University Hospital, 5 Hak-dong, Gwangju, 501-746, Republic of Korea.
Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, South Korea.
BMC Anesthesiol. 2021 Apr 22;21(1):126. doi: 10.1186/s12871-021-01344-3.
Nasotracheal intubation is a very useful technique for orofacial or dental surgery. However, the technique itself can be more traumatic than that of orotracheal intubation. Complications such as turbinectomy or bleeding are often reported. However, little is known about the follow-up of patients after these complications.
The present case describes an accidental middle turbinectomy that led to endotracheal tube obstruction during nasotracheal intubation, and discusses its long-term follow-up. A 19-year-old man underwent mandibular surgery under general anesthesia and nasotracheal intubation. His right middle turbinate was completely avulsed and became firmly occluded within the tube during nasotracheal intubation. The nasotracheal intubation was performed again and the operation was completed safely. The patient was discharged without sequelae after postoperative care. However, he had symptoms of nasal obstruction and sleep disturbance for 3 months postoperatively. Synechiae were detected between the nasal septum and lateral nasal wall on a right rhinoscopic examination and facial computed tomography at 3 months postoperatively. Additionally, he showed ipsilateral maxillary sinusitis on facial computed tomography at the 2-year follow-up examination.
Nasotracheal intubation can cause late complications as well as early complications. Therefore, if nasotracheal intubation is to be performed, the anesthesiologist should identify the nasal anatomy of the patient accurately and prepare appropriately. In addition, if complications occur, follow-up observation should be performed.
经鼻插管是口腔颌面或牙科手术非常有用的技术。然而，该技术本身比经口插管更具创伤性。常报道有鼻甲切除术或出血等并发症。然而，对于这些并发症后患者的随访情况知之甚少。
本病例描述了一例意外的中鼻甲切除术，导致经鼻插管时气管内导管阻塞，并讨论了其长期随访情况。一名 19 岁男性在全身麻醉下接受下颌骨手术和经鼻插管。他的右侧中鼻甲完全撕脱，在经鼻插管时被牢固地阻塞在管内。再次进行经鼻插管，手术安全完成。患者在术后护理后无后遗症出院。然而，他在术后 3 个月出现鼻塞和睡眠障碍症状。术后 3 个月的右鼻内镜检查和面部计算机断层扫描显示鼻中隔和外侧鼻壁之间存在粘连。此外，在 2 年的随访检查中，面部计算机断层扫描显示他同侧上颌窦炎。
经鼻插管可引起迟发性并发症和早期并发症。因此，如果要进行经鼻插管，麻醉师应准确识别患者的鼻腔解剖结构并做好适当准备。此外，如果发生并发症，应进行随访观察。
