Preventing Pressure Sores of the Nasal Ala After Nasotracheal Tube Intubation: From Animal Model to Clinical Application

Huang, Tze-Ta; Tseng, Chih-En; Lee, Tsan-Mu; Yeh, Jen-Ying; Lai, Yu-Yung

doi:10.1016/j.joms.2008.06.100

« Previous Next »Journal of Oral and Maxillofacial Surgery
Volume 67, Issue 3 , Pages 543-551, March 2009

Preventing Pressure Sores of the Nasal Ala After Nasotracheal Tube Intubation: From Animal Model to Clinical Application

Tze-Ta Huang, DDS, MS
- Director of Dental Department, Department of Oral and Maxillofacial Surgery, School of Medicine, Tzu Chi University, Taiwan, Republic of China
Chih-En Tseng, MD
- Director, Department of Pathology, School of Medicine, Tzu Chi University, Taiwan, Republic of China
Tsan-Mu Lee, MS
- Research Assistant, Department of Anesthesiology, Buddhist Dalin Tzu Chi General Hospital, Dalin, Taiwan, Republic of China
Jen-Ying Yeh, BS
- Research Assistant, Department of Oral and Maxillofacial Surgery, Buddhist Dalin Tzu Chi General Hospital, Dalin, Taiwan, Republic of China
Yu-Yung Lai, MD
- Visiting Staff, Department of Anesthesiology, Buddhist Dalin Tzu Chi General Hospital, Dalin, Taiwan, Republic of China
- Address correspondence and reprint requests to Dr Lai: Department of Anesthesiology, Buddhist Dalin Tzu Chi General Hospital, No. 2 Min-Sheng Road, Dalin Town, Chia-Yi, Taiwan, Republic of China

Purpose

Nasal-ala pressure sores induced by nasotracheal intubation are common complications of oral and maxillofacial surgery, but are easily ignored. To determine whether such sores could be prevented, we studied the effects of a combination of cushioning material in an animal model, and then analyzed the efficacy of this combination clinically.

Materials and Methods

Four pigs received nasotracheal intubation. Each pig received intubation for 4, 8, 12, or 16 hours. Outcomes from pigs undergoing 500-gram-weight compression on each nostril were compared: one nostril received an application of cushioning materials, and the contralateral nostril did not. After the required study period, clinical assessment and further evaluation were performed by measuring pressure-sore dimensions and performing incisional biopsies. Clinical applications of this protective technique were then undertaken. Eight patients who underwent intubation without Soft Liner (GC Co, Tokyo, Japan) and DuoDERM CGF (ConvaTec, Inc, Princeton, NJ) protection, and 10 patients with Soft Liner and DuoDERM protection, were evaluated.

Results

The protective efficacy of the cushioning materials was significant in the animal model as well as in clinical practice. Pressure sores were avoided on the protected side, with severe tissue necrosis documented on the control side.

Conclusion

We found that the combined use of Soft Liner and DuoDERM reduced the size and severity of nasal-ala pressure sores attributable to nasotracheal intubation during oral and maxillofacial surgery.