Nasal Alar Pressure Ulcer After Orthognathic Surgery: Clinical Presentation and Preventive Recommendations

Nasotracheal intubation is routinely used in patients undergoing oral and maxillofacial surgery when intermaxillary fixation is needed either intraoperatively or postoperative. Various complications can occur such as epistaxis, turbinectomy, retropharyngeal dissection, tympanites, and nasal alar pressure sores or necrosis, especially when there is a prolonged nasotracheal intubation. The first report of a nasal alar necrosis after prolonged nasotracheal intubation was published by Hatcher et al in 1968. Since then several reports of skin necrosis of the nasal alar region have been published and attributed to a prolonged operation or the technique used in tube placement. Pressure ulcers are a localized damage to the skin and underlying soft tissue and usually appear immediately after the procedure. They start with nonblanchable erythematous intact skin and can evolve to partial thickness loss of skin with exposed dermis and scab formation during the healing process. They may be painful and can cause a cosmetic problem for patients. The literature has several studies of nasal alar necrosis after nasotracheal intubation for head and neck reconstructive surgery, but there is no description of this complication after orthognathic surgery. This paper describes the occurrence of skin nasal alar necrosis following a bimaxillary jaw correction and highlights recommendations for its management and prevention.