Journal: J Clin Anesth 19(8):619-621, 2007. 14 References
Reprint: Dept of Anesthesiology and Division of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham School of Medicine, Birmingham, AL 35249 (RD Vincent, MD)
Faculty Disclosure: Abstracted by R. Ouellette, who has nothing to disclose.
The Glidescope video laryngoscope promises to facilitate difficult tracheal intubations in cases of anatomical abnormality of the airway or where cervical immobilization is desired. The authors present a case of soft palate perforation during oral endotracheal intubation associated with the use of the Glidescope video laryngoscope. A 55-year-old man with a 30-year history of cigarette smoking presented with hoarseness, dysphagia, hemoptysis, inspiratory stridor at rest. On videoscope he was noted to have a large exophytic right supraglottic mass. A direct laryngoscopy and biopsy was scheduled.
After induction of general anesthesia the Glidescope laryngoscope was positioned in the vallecula during visualization of the attached video monitor. Subsequently a 6.5 mm endotracheal tube reshaped with a stylette was placed into the oropharynx and advanced until it was visualized on the monitor. The large tumor almost completely obstructed the laryngeal inlet. Nevertheless, with firm pressure and gentle manipulation the ETT was passed into the trachea. Shortly after the introduction of the rigid laryngoscope, the otorhinolaryngologist noted a soft palate perforation from the ETT. Surgery proceeded uneventfully and the palatal defect was not repaired. The patient was subsequently discharged from the ambulatory surgical facility and follow up showed no palatal defect detected.
Successful tracheal intubation facilitated with the Glidescope necessitates extreme flexion of the distal portion of the ETT. Therefore, the tube is somewhat more difficult to pass through the oropharynx, which may dispose to a greater propensity for palatal trauma. Furthermore, the reusable stylette provided with the Glidescope is substantially more rigid than the disposable stylettes typically available. The authors believed these two factors combined to cause the palatal perforation observed in the case.
More serious complications of soft palate perforations include internal carotid artery thrombosis or pseudoaneurysm, thrombosis of the internal jugular vein, and mediastinitis. Perforations near the midline are less likely to result in carotid artery injury. Treatment of traumatic soft palate perforations may include either primary repair or continued observation. |
