Bhattacharyya N, Gopal H V
Joint Center for Otolaryngology, Boston, MA 02115, USA.
Ann Otol Rhinol Laryngol. 1998 Aug;107(8):662-4. doi: 10.1177/000348949810700806.
Several cases of intracranial injury during the placement of nasogastric tubes have been reported, usually in the setting of anterior skull base fractures. The fovea ethmoidalis and sphenoid sinus are often exposed after endoscopic sinus surgery, so that these structures are potentially placed in the line of contact during nasogastric tube placement. In order to evaluate the ability of the fovea ethmoidalis and roof of the sphenoid sinus to withstand penetration from possible contact during nasogastric tube placement, 12 fresh cadaver heads were studied. After complete endoscopic ethmoidectomy and wide sphenoidotomy, standard 18F and 16F nasogastric tubes were inserted to produce deliberate direct contact with both the fovea ethmoidalis and the sphenoid sinus roof. No penetrations of the fovea occurred in 20 specimen sides with the 18F tube; penetration did occur with the 16F tube in 1 of 13 sides (7.7%). With respect to the sphenoid sinus, no intracranial penetrations occurred in 16 and 11 sides for the 18F and 16F tubes, respectively. The sphenoid sinus was easily entered even in the presence of an intact middle turbinate. These data suggest that although intracranial penetration during nasogastric intubation after endoscopic sinus surgery is an unlikely event, there is a non-negligible risk of such injury. Nasogastric intubation should be performed with caution in patients with a history of sinus surgery.
已有数例在放置鼻胃管过程中发生颅内损伤的报道，通常发生在前颅底骨折的情况下。在内镜鼻窦手术后，筛骨筛凹和蝶窦常暴露在外，因此在放置鼻胃管时这些结构有可能处于接触线上。为了评估筛骨筛凹和蝶窦顶部在鼻胃管放置过程中承受可能接触造成的穿透的能力，对12个新鲜尸体头部进行了研究。在完成内镜筛窦切除术和广泛的蝶窦切开术后，插入标准的18F和16F鼻胃管，使其与筛骨筛凹和蝶窦顶部直接接触。使用18F管时，20个标本侧均未发生筛凹穿透；使用16F管时，13个侧中有1个侧发生穿透（7.7%）。对于蝶窦，使用18F管和16F管时，分别有16个侧和11个侧未发生颅内穿透。即使中鼻甲完整，蝶窦也很容易被进入。这些数据表明，尽管内镜鼻窦手术后鼻胃管插管期间发生颅内穿透是不太可能的事件，但这种损伤的风险不可忽视。有鼻窦手术史的患者在进行鼻胃管插管时应谨慎操作。
