Intracranial placement of a nasotracheal tube after transnasal trans-sphenoidal surgery

Abstract

Intracranial misplacement of a tracheal tube during attempted nasotracheal intubation is a rare, usually lethal complication. Such incidents are associated with fractures of the face and base of the skull. We report inadvertent intracranial placement of a nasotracheal tube in a patient who had 2 weeks previously undergone transnasal trans-sphenoidal surgery for a pituitary tumour. One should be aware that transnasal trans-sphenoidal surgery leaves a bony defect in the skull, which is susceptible to perforation by nasally introduced tubes.

The nasal intubation aid

“…Since I now use a fibreoptic laryngoscope for most of my nasal intubations for training purposes, I have found an equally low incidence of epistaxis. I completely agree with the authors' sentiments regarding the NIA and feel that efforts to reduce trauma during nasal intubation are essential, especially as rare but life‐threatening complications of nasal intubation continue to be reported [1].…”

A study of submental intubation for anaesthesia in patients with faciomaxillary injuries

“…Mucosal dissection, injury to adenoids, meningitis, sepsis, sinusitis, epistaxis, dislodgement of bony fragments and obstruction of the tube by distorted airway and rarely intracranial intubation are the potential complications of nasotracheal intubation. 11,12 In such situations tracheostomy is conventional choice of securing airway. However tracheostomy is associated with its own complications.…”

A rare complication of Epistats

“…Nasally placed airways have been implicated in intracranial penetration in six published reports to date [46][47][48][49][50][51]. Three of these patients had significant preceding trauma, one had a known pituitary lesion, one had facial dysmorphic features and one was a preterm infant.…”