Management of a perforated endotracheal tube during orthognathic surgery

Oral and maxillofacial procedures require nasotracheal intubation that often obscures the anesthesiologist's direct vision of the surgical field. Premature extubation of a damaged endotracheal tube frequently requires replacement and poses a potential risk to the patient. This case illustrates a technique for replacing a damaged endotracheal tube using a nasogastric tube inserted within the damaged tube to suction secretions, insufflate oxygen, and serve as a guide for placement of a new endotracheal tube.