Abstract

Nasotracheal intubation is commonly used in patients undergoing maxillofacial surgery. The tracheal tube is passed through the nasal cavity after induction of anesthesia, followed by direct laryngoscopy to insert the tube into the trachea under direct vision by using Magill forceps. Various complications resulting from nasal passage of the tube, such as epistaxis, turbinectomy or retropharyngeal dissection, have been reported. The most common complication of nasotracheal intubation is epistaxis and several recommendations have been made to reduce its incidence. In spite of efforts such as local application of vasoconstrictive drugs, thermosoftening of the tube, and use of a nasopharyngeal airway as a pathfinder, epistaxis cannot be prevented entirely. This case report describes an 18-year-old female patient with difficult nasal intubation due to narrow nasal passageway. The patient was admitted for mandible angle splitting ostectomy and angle resection for cosmetic purpose. Epistaxis had occurred due to repeated nasotracheal intubation attempts, and blood had been aspirated. After intubation, the patient was desaturated (SpO₂<92%) with asymmetric inflation of the chest wall during controlled ventilation. We took frequent suction and tube lavage with saline, thereafter changed patient’s position to right lateral decubitus, and chest percussion was done with a face mask and the palm of the hand. About 20 minutes after aspiration, the SpO₂ was restored to 98%, and the operation proceeded, which finished uneventfully. On the next day, the chest x-ray revealed segmental atelectatic change in the right lung field, and nasal packing was done because of recurrent epistaxis. The patient was discharged on the 4th postoperative day without complications.

• Keywords: Nasal intubation, Complication, Epistaxis, Chest percussion, Postural drainage