[Lesions to lips, oral and nasal cavities, pharynx, larynx, trachea and esophagus due to endotracheal intubation and its alternatives].
Dysphagia of greater than 48 h duration is an indication for indirect laryngoscopy and when odynophagia and otalgia occur simultaneously, the possibility of subluxation of the arytenoids demands an urgent ENT assessment. The potential seriousness of laryngeal lesions following intubation obliges us to use the smallest compatible endotracheal tube. The occurrence of pain cervical surgical emphysema and fever suggests a pharyngeal lesion necessitating the suspension of oral feeding and the initiation of antibiotic therapy with anaerobic activity, while awaiting possible surgical intervention. There is no argument to use a tooth-guard for each intubation, but tooth fragility must be researched. The incidence of nasal fossa trauma is reduced with the use of nasal packs impregnated with local anaesthetic containing a vasoconstrictor. This allows the introduction of a small flexible lubricated tube. Laryngeal mask-induced sore throat is more common than the more serious injuries. The classical technique of introducing a laryngeal mask of appropriate size (4 for women, 5 for men) in which the cuff is inflated to a leak pressure of 20 cm H(2)O reduces this frequency. The facial mask may cause injuries especially with prolonged use. The incidence of pulmonary aspiration, linked to the action of drugs, raised intra-abdominal pressure; an emergent situation or difficult intubation is decreased with the performance of the Sellick maneuver at intubation, rapid induction and the neutralization of gastric acidity. A meticulous technique of insertion of the, individualized anaesthesia, particular vigilance at the time of decurarisation and position changes and a calm awakening assure its optimal use, unless the Proseal laryngeal mask modifies this point of view.
Lacau Saint Guily
J
J
Service d'ORL et chirurgie cervico-faciale, hôpital Tenon, 75970 Paris cedex 20, France.
Boisson-Bertrand
D
D
Monnier
P
P
D004947:Esophagus / Q000293:injuries; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D017214:Laryngeal Masks / Q000009:adverse effects; D007830:Larynx / Q000293:injuries; D008046:Lip / Q000293:injuries; D009055:Mouth / Q000293:injuries; D009296:Nasal Cavity / Q000293:injuries; D010614:Pharynx / Q000293:injuries; D012137:Respiratory System / Q000293:injuries*; D018677:Tooth Injuries / Q000209:etiology; D014132:Trachea / Q000293:injuries