Pharyngoplasty: a hazard for nasotracheal intubation

Area of Science:

• Oral and Maxillofacial Surgery
• Anesthesiology
• Otolaryngology

Background:

• General anesthesia is frequently required for oral and maxillofacial procedures.
• Nasotracheal intubation is a critical technique for specific surgeries like orthognathic surgery.
• Pharyngoplasty can alter airway anatomy, potentially complicating intubation.

Observation:

• Patients who have undergone pharyngoplasty may exhibit a reduced velopharyngeal orifice.
• This anatomical change can impede the passage of a nasotracheal tube.
• Assessing the velopharyngeal orifice is crucial for successful intubation.

Findings:

• Nasotracheal intubation can be difficult in patients with a history of pharyngoplasty.
• The reduced velopharyngeal orifice size is a primary factor contributing to intubation challenges.
• Preoperative evaluation is essential to identify potential intubation difficulties.

Implications:

• Nasal pharyngoscopy or similar investigations should be part of the preoperative assessment for patients undergoing pharyngoplasty.
• This proactive assessment can prevent complications associated with difficult nasotracheal intubation.
• Optimizing airway management improves patient safety in oral and maxillofacial surgery.