Limited Nasal Intubation Route After Pharyngeal Flap Surgery: A Case Report

Area of Science:

• Anesthesiology
• Otolaryngology
• Plastic Surgery

Background:

• Patients with a history of cleft lip and palate undergoing orthognathic surgery present unique airway management challenges.
• Nasal intubation is often preferred for orthognathic surgery but can be complicated by anatomical variations such as nasal adhesions and pharyngeal flaps.

Purpose of the Study:

• To describe a successful anesthetic and airway management strategy for a patient with a history of cleft lip and palate and a pharyngeal flap undergoing bilateral sagittal split ramus osteotomy.
• To highlight the importance of preoperative assessment and multimodal intubation techniques in complex airway cases.

Main Methods:

• Preoperative assessment including imaging and nasopharyngeal endoscopy was performed.
• Initial airway secured via oral intubation due to nasal adhesions.
• Nasotracheal intubation was successfully achieved using fiberoptic bronchoscopy guidance through the left nasal cavity and left pharyngeal flap orifice.
• Postoperative airway assessment was conducted prior to extubation.

Main Results:

• Successful nasotracheal intubation was achieved despite anatomical challenges, ensuring patient safety.
• Pharyngeal flap integrity was maintained throughout the procedure.
• No airway complications were reported postoperatively.

Conclusions:

• Comprehensive preoperative planning, including simulation and strategy validation, is crucial for managing complex airways in patients with cleft lip and palate.
• Fiberoptic-guided nasotracheal intubation through a pharyngeal flap orifice is a feasible technique when standard nasal intubation is not possible.
• Multidisciplinary collaboration and meticulous technique are essential for successful outcomes in challenging anesthetic cases.