title: 18-gauge needle cap as adjunct to prevent kinking of endotracheal tube.
abstract: A self-retaining Dingman mouth retractor is widely used to keep the mouth open during cleft palate and intraoral surgery. The airway is at risk of being crushed or occluded as the gag (tongue plate) of the Dingman mouth retractor is being pushed against the endotracheal tube.Kinking of the endotracheal tube between the teeth and Dingman mouth retractor has been reported even with the oral Ring-Adair-Elwyn or flexometallic or armored endotracheal tubes. To minimize kinking of the endotracheal tube and its consequent complications, we routinely insert an 18-gauge needle cap at the potential space between the teeth and the tongue plate (gag) of the Dingman mouth retractor, which is situated lateral to the endotracheal tube. In our experience of approximately 5000 intraoral cases using a Dingman mouth retractor and 18-gauge needle cap, we have not had any tooth avulsion or aspiration of the 18-gauge foreign body while maintaining a consistent and secured airway during cleft palate and intraoral surgery.
authors.affiliation: Division of Plastic and Reconstructive Surgery, David Geffen School of Medicine, University of California, Los Angeles (UCLA) School of Medicine, Los Angeles, CA 90095-6960, USA.
authors.forename: Fuan Chiang
authors.initials: FC
authors.lastname: Chan
authors.forename: Henry K
authors.initials: HK
authors.lastname: Kawamoto
authors.forename: James P
authors.initials: JP
authors.lastname: Bradley
mesh_terms: D004867:Equipment Design; D004868:Equipment Failure; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D009339:Needles; D019647:Oral Surgical Procedures; D013525:Surgical Instruments