An Unusual Lacerated Tracheal Tube during Le Fort Surgery
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Abstract :
Maxillofacial surgeries can present unique anesthetic challenges due to potentially complex anatomy and the close proximity of the patient's airway to the surgical field. Damage to the tracheal tube (TT) during maxillofacial surgery may lead to significant airway compromise. We report the management of a patient with a partially severed TT during Le Fort surgery for midfacial hypoplasia and management strategies based on peer-reviewed literature. This case illustrates the clinical clues associated with a damaged TT and explores the challenges of managing this potentially catastrophic issue.

Case :
A 17-year-old, 56 kg male with midface hypoplasia presented for an elective Le Fort-1 advancement surgery with bilateral malar osteotomies. His prior medical history was unremarkable. On physical examination, the patient had a Mallampati-2 airway, and his mental-hyoid distance, mouth opening, and mandibular subluxation were normal. Anesthesia was induced with sevoflurane and oxygen, obtained peripheral IV access, and applied oxymetazoline to both nares prior to smooth nasotracheal intubation with a 6.5 cuffed TT. The TT cuff was inflated with 3?mL of air; auscultation, squeezing of the pilot balloon, and palpation of the patient's neck confirmed the TT cuff's proper inflation and position......

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5118511/
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