Abstract
A surgical needle will generally not penetrate an endotracheal tube (ETT) and intraoperative ETT cuff perforation is uncommon because the cuff, which is the weakest part of the tube, is placed in the subglottic trachea. We report a very rare case, in which an intraoperative airway air leak during maxillary advancement surgery was postoperatively confirmed to be due to ETT cuff deflation because of needle penetration of the cuff pilot line. We also measured the force required to penetrate the wall of the pilot line and the ETT wall, finding that the pilot line is vulnerable to a needle.
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