Inadvertent Intracranial Introduction of a Nasogastric Tube, a Complication of Severe Maxillofacial Trauma

Methods and Complications of Nasoenteral Intubation

“…It is evident that trauma can occur during placement of nasoenteral tubes anywhere along the track from the nares to the esophagus or tracheobronchial tree and beyond. Blind passage of nasoenteral tubes has resulted in many serious complications, including the creation of nasopharyngeal submucosal passages 44 ; intracranial placement in patients with facial fractures, facial trauma, 45 ‐ 57 and recent facial surgery 58 ; esophageal perforation 59 ‐ 63 ; bronchopulmonary intubation 64 , 65 ; pneumothorax 66 ‐ 77 ; hydrothorax 78 , 79 ; empyema 79 ; and pneumonia 80 . In addition, nasogastric tube placement is hemodynamically stimulating, 35 and hypertensive responses to nasogastric tube insertion may occur 81 .…”

Use of Nasogastric Tubes in Trauma Patients – A Review

“…Most of these were in trauma patients with known or suspected basal skull fracture. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] There were three reports of intracranial NGT placement in patients with pituitary tumours, [19][20][21] one in a preterm infant [22], and two in unconscious adult patients without significant mechanical trauma. [23,24] Rahimi-Movaghar et al [12] described the insertion of a nasogastric tube in a 34 year old man who had been injured in a fall from height.…”

“…Three papers [3,17,20] attributed the patient's death directly to intracranial placement of an NGT. One patient died during craniotomy to remove the tube [10]. Death was considered to be caused by other injuries in two cases [9,8].…”

Complications of Gastrointestinal Intubation

“…3-1). Seebacher et al reported a similar case in which a nasogastric suction tube blindly inserted in a victim of an automobile accident crossed the cribriform plate and curled within the cerebral cavity (29). These authors also noted that in the presence of fractures of the paranasal sinuses the nasogastric tube may enter the maxillary sinus or the orbits.…”