Michiharu Shimosaka

By Michiharu Shimosaka

We experienced a case of endotracheal tube damage during maxillomandibular osteotomy found by bronchofiberscope. The patient was a 22-year-old man, scheduled for maxillomandibular osteotomy under general anesthesia for the treatment of two jaws deformity. Tracheal intubation of Microcuff subglottic endotracheal tube (I.D.7.5 mm made by Halyard Health Care Inc.) was via the left nasal cavity. The surgery started from maxilla and became the maxillary transection approximately 50 min later. There was the indication of the ventilation gas leak from the operation after the maxillary transection, but we confirmed that, and there was no tube in the clear abnormal findings with bronchofiberscope. Because the positive pressure ventilation was possible, and the ventilation had no problem, we decided to resume surgery. After maxillary fixation was completed approximately 3 and a half hours later, and confirming with bronchofiberscope again, we confirmed an inflow of the blood in a tube and confirmed a tube laceration to around 4–5 cm from the nasal cavity entrance. We decided to conduct tube exchange. After the surgery, the cause of tube rupture was examined; it was then found that the tube was damaged by a bone chisel used during maxillary bone dissection. When there is doubt about a endotracheal tube damage, confirmation of the inner surface using a bronchofiberscope is useful, and it is important to grasp the case early.

Part of the book: Bronchitis in Children