INTRODUCTION 
Epistaxis , bacteremia, mucosal tears, sinusitis, turbinate 
avulsion, perforation of pyriform fossa etc are some of the 
complications following nasotracheal intubation. We report a 
case of previously undetected nasal spur leading to 
endotracheal tube cuff tear which adjoined to the difcult 
airway senario in a patient with temporo- mandibular joint 
ankylosis.

Case report 
An 18 year old patient with temporo-mandibular joint 
ankylosis was posted for gap arthroplasty. Airway assessment 
revealed decreased mouth opening of 1 cm measured incisor 
to incisor and right nostril patency more than the left. 
Successful placement of breoptic guided nasotracheal tube 
was done via the right nostril but ination of the endotracheal 
cuff failed. Suspecting a defect in the cuff, endotracheal tube 
was exchanged with another using Cook's airway exchange 
catheter. Astonishingly, cuff ination failed yet again. 
Suspecting some pathology along the nasal passage , 
breoptic nasal intubation was done through left nostril with 
successful cuff ination. Intra operative period was uneventful 
and nasal endoscopy was done prior to extubation which 
revealed a sharp spur in the right nostril.

DISCUSSION
The cuff of the endotracheal tube can be damaged due to 
multiple reasons during its passage through the nasal cavity 
with deviated nasal septum or any abnormal bony structure . 
Nasal endoscopy/ breoptic bronchoscopy may reveal such 
pathologies in airway anatomy but our institutional practice of 
using a split nasal airway led us to miss the nasal spur. The 
extent of the nasal examination is debatable especially if the 
bilateral nasal cavities are patent.

CONCLUSION
Endotracheal tube cuff tear by a nasal spur is rare. But an 
anaesthesiologist should remain abreast of this airway 
anomaly, impending complications and immediate 
management during nasotracheal intubation.

REFERENCES
1. Coe T. R., Human M. The perioperative complications of nasal intubation: a 

comparison of nostril side. Anaesthesia 2001;56:227-84.
2. Feng YP, Lee CY, Luk HN, Peng SY. Cuff damage caused by a nasal spur 

during nasotracheal intubation: A case report. Fu- Jen Journal  of Medicine 
2014;12(2):119-24.

ENDOTRACHEAL CUFF TEAR DURING AWAKE FIBREOPTIC GUIDED 
NASOTRACHEAL INTUBATION- AN ANAESTHESIOLOGIST'S NIGHTMARE - 

A CASE REPORT

Original Research Paper

Dr. Garima Anant*
Assistant Professor Department of Anaesthesia, P.G.I.M.S, Rohtak
 *Corresponding Author

  X 1GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS

Anaesthesiology

Various factors may contribute to the endotracheal tube cuff tear during nasotracheal intubation. We 
report a sharp nasal spur in the right nostril leading to failed cuff ination. An 18 year old male with TM 

joint ankylosis was posted for gap arthroplasty. Twice after successful bre-optic guided  nasotracheal intubation but failed cuff 
ination via the right nostril, a successful attempt was made at nasotracheal intubation with cuff ination via the left nostril. Cuff 
tear caused by a nasal spur is infrequent, but an  anaesthesiologist should be abreast of this complication and its subsequent 
management during nasotracheal intubation.

ABSTRACT

KEYWORDS : 

VOLUME-9, ISSUE-1, JANUARY-2020 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra

Dr. Aman Kaur 
Saini

Post Graduate MD First Year Student Department of Anaesthesia, P.G.I.M.S, 
Rohtak