Palatal and retropharyngeal injury secondary to intubation using the GlideScope® video laryngoscope

Abstract

Introduction There are few reports of injury to the soft palate and retropharynx sustained during intubation with the GlideScope® video laryngoscope. Most reports are of isolated injury to the soft palate. Case History We describe a patient in whom the retropharynx was injured but the extent of the injury was not observed initially. The patient did not suffer severe sequelae from this injury. However, this injury can cause serious sequelae if it is not recognised (eg development of a retropharyngeal abscess). Conclusions We recommend that any patient who sustains injury to the soft palate during intubation (particularly if the endotracheal tube passes through the soft palate) should be reviewed an otolaryngologist before removal of the endotracheal tube.

Dangers of Videolaryngoscopy-Assisted Intubation: Risk for Multiple Otolaryngologic Complications

“…Many authors suggest that injury most likely occurs during blind introduction of the endotracheal tube into the oropharynx, while the operator is focused on the video monitor instead of the oral cavity [12]. Thusly, emphasis has been placed on ensuring the endotracheal tube is directly seen passing into the oral cavity before attention is diverted to the video monitor [8]. Risk for injury can be further increased with the use of rigid stylets, and as such, softer malleable stylets are recommended [8,12].…”

“…Thusly, emphasis has been placed on ensuring the endotracheal tube is directly seen passing into the oral cavity before attention is diverted to the video monitor [8]. Risk for injury can be further increased with the use of rigid stylets, and as such, softer malleable stylets are recommended [8,12].…”

“…There were no carotid injuries in our case series and neck imaging was not obtained. Finally, in the event of injury, extubation should not be performed until repair, hemostasis, and confirmation of no additional injuries has been accomplished [8,12]. Confirmation of lack of additional injuries may require direct laryngoscopy or incising the involved tonsillar pillars or soft palate in order to safely retape the endotracheal tube and allow for full visualization of the oral cavity and palate.…”

“…However indirect visualization is not without its weaknesses, as the technique predisposes to inherent blind spots in the oropharynx, which increases the risk for injury [2,7]. The reported incidence of videolaryngoscopy-related complications is 1%, the majority of which are minor injuries [8][9][10][11]. Significant palatal injuries are not uncommon, however, and often require procedural intervention from an otolaryngologist.…”

Difficult tracheal tube passage and subglottic airway injury during intubation with the GlideScope® videolaryngoscope: a randomised, controlled comparison of three tracheal tubes

“…Tracheal intubation can cause various acute airway injuries, including: arytenoid subluxation; supraglottic or glottic haematoma; laceration of the glottic mucosa and vocal cord; tracheal rupture; and mediastinal emphysema . Some supraglottic injuries, such as perforation of the soft palate, palatoglossal arch and palatopharyngeal arch, have been reported with the Glidescope ; possible reasons include the use of excessively large blades, rigid stylets, and unnecessary force during intubation . Jeon et al suggested that a forceps‐guided tube exchanger is better than a stylet in decreasing the incidence of sore throat when intubating with the Glidescope .…”