Use of a Modified Endotracheal Tube for Postoperative Intranasal Hemorrhage

Abstract

Orthognathic surgery may induce hemorrhage resulting from nasal mucosal injury or from maxillary osteotomy sites, and if severe, the hemorrhage may cause airway obstruction. The patient in this case report was a 27-year-old woman who underwent Le Fort I and bilateral sagittal split osteotomies under general anesthesia. There were no abnormal intraoperative vital signs. However, immediately after the patient was returned to the ward, significant bleeding that required frequent suctioning was observed in the oral cavity. As the bleeding persisted, the surgeon attempted to insert epinephrine-soaked gauze and polyvinyl acetal sponges into both nasal cavities, but hemostasis was difficult to obtain. To achieve hemostasis by compression/closure at the choana and maintain nasal patency, we inserted a modified cuffed endotracheal tube to serve as a transnasal airway and a choanal hemostatic balloon. This method resulted in hemostasis. The volume of blood loss after returning to the ward was approximately 420 mL. The transnasal airway and choanal balloon was useful for airway management and the prevention of intranasal bleeding into the lower pharyngeal regions. Furthermore, the method was simple and minimally invasive, suggesting its clinical usefulness in similar situations.