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Nasogastric Tube Knotted Around a Nasal Endotracheal Tube in the Nasopharynx: Possible Cause
Yunosuke OkadaDDS,
Hanako OhkeDDS,
Hiroyo YoshimotoDDS, PhD,
Misato KobashiDDS,
Masato SaitohDDS, PhD, and
Makoto TerumitsuDDS, PhD
Article Category: Case Report
Volume/Issue: Volume 68: Issue 2
Online Publication Date: Jun 29, 2021
DOI: 10.2344/anpr-67-04-01
Page Range: 90 – 93

Concomitant use of a nasogastric tube (NGT) and a nasal endotracheal tube (NETT) is common during oral surgery and dental treatment under general anesthesia; however, numerous complications associated with NGTs have been reported, ranging from minor to life-threatening. 1 One of these complications, knotting of the NGT, can occur during its insertion or removal. This can occur as an isolated event or the NGT can become entangled with another object, such as the NETT. Furthermore, the knotting can cause kinking or breakage of the NGT, 2

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Figure 2.; Nasogastric tube (NGT) tightly knotted to the withdrawn nasal tracheal tube (NETT).
Yunosuke Okada,
Hanako Ohke,
Hiroyo Yoshimoto,
Misato Kobashi,
Masato Saitoh, and
Makoto Terumitsu
Figure 2.
Figure 2.

Nasogastric tube (NGT) tightly knotted to the withdrawn nasal tracheal tube (NETT).

Figure 1.; Radiographic image of head and neck. Loop of nasogastric tube shown in hypopharynx (white arrow) and knot shown in nasopharynx (black arrow).
Yunosuke Okada,
Hanako Ohke,
Hiroyo Yoshimoto,
Misato Kobashi,
Masato Saitoh, and
Makoto Terumitsu
Figure 1.
Figure 1.

Radiographic image of head and neck. Loop of nasogastric tube shown in hypopharynx (white arrow) and knot shown in nasopharynx (black arrow).

Figure 3.; Model used to theorize how the nasogastric tube (NGT) might have become knotted around the nasal tracheal tube (NETT). (A) The NGT folded and turned backward toward the oropharynx, leading to its appearance in the oral cavity after the first (blinded) intubation attempt. (B, C) The NGT and NETT became entwined and formed a loose knot, although this maneuver was performed under direct vision with forceps. (D) The motion of pulling the NGT (arrow) to move the knot upward toward the nasopharynx led to tight knotting of the NGT to the NETT.
Yunosuke Okada,
Hanako Ohke,
Hiroyo Yoshimoto,
Misato Kobashi,
Masato Saitoh, and
Makoto Terumitsu
Figure 3.
Figure 3.

Model used to theorize how the nasogastric tube (NGT) might have become knotted around the nasal tracheal tube (NETT). (A) The NGT folded and turned backward toward the oropharynx, leading to its appearance in the oral cavity after the first (blinded) intubation attempt. (B, C) The NGT and NETT became entwined and formed a loose knot, although this maneuver was performed under direct vision with forceps. (D) The motion of pulling the NGT (arrow) to move the knot upward toward the nasopharynx led to tight knotting of the NGT to the NETT.

Hair Tourniquet Syndrome in the Dental Patient
Jason R. FloresRN, DDS
Article Category: Other
Volume/Issue: Volume 61: Issue 3
Online Publication Date: Jan 01, 2014
DOI: 10.2344/0003-3006-61.3.111
Page Range: 111 – 112

Hair tourniquet syndrome (HTS) is a condition where a hair strand will circle and become entangled around an appendage. In some cases a formidable knot will form, and the resulting tightened noose will slowly strangulate the appendage. Unfortunately, the first instinct of the patient or parent is to tug at the loose hair, which only further complicates the problem, and pain from ischemia may start. Without immediate release, the appendage may be lost. HTS usually affects the fingers, toes, wrists, penis or scrotum, vaginal labium