Nasal intubation is often required during oral surgery; however, nasal intubation can cause various complications including bleeding associated with nasal mucosal trauma during intubation and obstruction of the endotracheal tube. Two days before surgery, a nasal septal perforation was identified using computed tomography during a preoperative otorhinolaryngology consultation for a patient planned to undergo a nasally intubated general anesthetic. Subsequently, nasotracheal intubation was successfully performed after confirming the size and location of the nasal septal perforation. We used a flexible fiber optic bronchoscope to safely perform the nasal intubation while assessing for inadvertent migration of the endotracheal tube or soft-tissue damage around the perforation site. Careful preoperative planning in cooperation with the otorhinolaryngology department and use of computed tomography is recommended when a nasal abnormality is suspected.
Clinical and Radiographic Imaging of the Nasal Septal Perforation.
Size and location of nasal septal perforation as seen through the left lateral nasal cavity by bronchoscope and computed tomography.
Contralateral Intranasal View During Intubation.
View of the nasal endotracheal tube as seen from the contralateral side of the septal perforation.
Contributor Notes
eISSN: 1878-7177
ISSN: 0003-3006