External compression of a nasotracheal tube due to the displaced bony fragments of multiple LeFort fractures.

AIRWAY obstruction is a recognized life-threatening complication of facial fractures. Approximately 27% of patients who present with LeFort fractures require a tracheostorny or a tracheal intubation for the management of airway obstruction or respiratory depression. ' However, obstruction of a secured endotracheal tube caused by external compression of the fracture fragments has not been reported. We present a case of intraoperative airway obstruction in a patient with multiple LeFort fractures that occurred despite the placement of a nasotracheal tube in situ. The anatomical features of facial fractures and the presence of a nasotracheal tube predisposed the patient to this complication. Nasotracheal intubation using fiber-optic guidance in patients with basal skull fracture and alternative airway-management strategies are discussed.