Partial Middle Turbinectomy by Nasotracheal Intubation

Abstract

Partial middle turbin ate avulsion is a rare complication of nasotracheal intubation. Patients usually experience a brisk hemorrha ge at the time of injury. Postop eratively, some pati ents develop a unilateral nasal obstruction, while others are asymptomatic. We present an unusual case in which a patient becam e symptomatic man y yea rs after the incident. We hope to raise awa reness that a traumatic disruption of the turbinates seco ndary to nasotra cheal intubation might lead to the developm ent of an abn ormal nasopharyngeal mass.

Nasal intubation: A comprehensive review

“…The middle turbinate is attached to the base of the cranium formed by cribriform plate by a thin lamella and it is highly vascular. Any trauma leading to avulsion of the middle turbinate can lead to massive epistaxis or cerebrospinal fluid rhinorrhea or injury to olfactory nerve secondary to damage to the cribriform plate;[14151617] this is very commonly seen with middle turbinate hypertrophy or concha bullosa. [18] Traditionally, it was also taught that lower pathway for nasal intubation is safer by advancing the ETT caudally along the floor of the nasal cavity away from the middle turbinate and cribriform plate to avoid trauma, thus supporting the thought.…”

Middle turbinectomy after nasotracheal intubation

“…Epistaxis and bruising are the most common complications seen in NTI, a result of injury to the nasal mucosa as the nasotracheal tube is passed posteriorly. There have been several previous case reports describing middle turbinectomy as a result of NTI [1][2][3][4][5][6][7]. To our knowledge, this is the first reported case in the radiology literature.…”

“…Middle turbinectomy is a rare complication of NTI. Preexisting intranasal abnormalities, such as an enlarged inferior turbinate or a septal spur, increase the risk of middle turbinate trauma during NTI by causing the nasotracheal tube to be redirected higher into the nasal cavity [7]. Although this complication may be missed on clinical exam, it is readily recognizable on CT imaging.…”

“…The basal lamella of the middle turbinate attaches to the cribriform plate and to the lamina papyracea. Applying excessive force to [7,8] or fracture of the medial orbital wall. The referring clinician should be alerted to these potential complications.…”

Retropharyngeal dissection during nasotracheal intubation: a rare complication and its management

“…Other complications include impingement of the ETT in the subglottic region, further hindering advancement after passing the glottis; sinusitis [5,6]; bacteremia [7]; and dislodgement of the adenoids [8]. Less common complications include unilateral nasal obstruction related to partial avulsion of the middle turbinate [9,10]. In addition, pharyngoesophageal perforation [11] and inadvertent intracranial placement of a nasotracheal tube [12] have been documented.…”