Ulceration of the nasal ala and dorsum secondary to improper support of the nasoendotracheal tube.

One facet of nasoendotracheal anesthesia which rarely gets sufficient attention is that of providing adequate support for the weight and position of the gas delivery hoses on the intubated patient. This article describes a means of avoiding an iatrongenic lesion resulting from inadequate support of anesthesia hoses and the nasoendotracheal tube. Ulceration or necrosis of the nasal ala and/or of the skin on the bridge of the nose are occasional sequelae of nasoendotracheal intubation. , 2. 8, 4 Gaisford has encountered five cases of postnasal intubation slough of the skin of the nostril, two of which required plastic repair. Barkin and Trieger have experienced five cases of postoperative necrosis of the alar integument. 2 While not among the myriad of dramatic, catastrophic problems sometimes associated with anesthesia (administered by any route), this type of iatrogenic lesion is worth reporting to emphasize its potential seriousness and ease of prevention. Besides possibly causing lesions of the nasal ala or dorsum, inadequately supported nasal (or oral) endotracheal tubes are subject to kinking. This kinking, at best, may result in the inconvenience of a halt in surgery while the anesthetist dives beneath the drapes to reposition the tube and, at worst, may give rise to the sequelae of airway obstruction. Moreover, the authors have seen a case where a patient, inadvertently extubated in an attempt to unkink the nasoendotracheal tube during a Le Fort I maxillary osteotomy, was almost lost.