Trans-septal Mattress Suture: Securing Naso-Endotracheal Tubes With Enhanced Stability and Aesthetic Preservation

Securing the endotracheal tube is vital for airway patency, especially in oral surgeries; naso-endotracheal intubation is ideal, but improper fixation risks nasal injury or accidental extubation. This technical note unveils the trans-septal mattress suture technique as a novel approach to secure naso-endotracheal tubes, amplifying stability, reducing trauma, and elevating aesthetic outcomes in head and neck surgeries. This study was performed at the Department of Oral and Maxillofacial Surgery at Kalinga Institute of Medical Sciences, Bhubhaneshwar, Khordha, Odisha, India, from December 2022 to March 2024 with due consent taken from all patients. Naso-endotracheal tube dislodgement during jaw fracture surgeries can cause nasal mucosa trauma and inadequate ventilation. Head and neck oncology cases require secure tube fixation due to prolonged intubation. Adhesive tapes lose adhesiveness, and fixators may obstruct visibility, while sutures offer reliable stabilization. A trans-columellar suture initially anchors the tube, but prolonged surgery risks skin necrosis and nasal deformity. Hence, we advocated a trans-septal mattress technique that relocates the knot to the septal area, preventing necrosis, ensuring stability, and minimizing postoperative deformity. Our trans-septal suture technique secures the naso-endotracheal tube by avoiding columellar scarring, ensuring better cosmesis while minimizing epistaxis risks. It offers a stable, cost-effective airway solution, ideal for prolonged surgeries, balancing function with aesthetics effectively.