Soft Palate Injuries During Orotracheal Intubation With the Videolaryngoscope.
OBJECTIVE
The videolaryngoscope has gained popularity for providing superior visualization in intubations. A rare complication of this technology is soft palate injury. Through a literature review and case series, we highlight the risks associated with the Glidescope and McGrath videolaryngoscopes and the management of soft palate injuries.


METHODS
A case series of multi-institutional review of medical records was performed to identify patients with soft palate injuries from the videolaryngoscope. A literature review was also performed to analyze risk factors, mechanism of injury, complications, and management of palate injuries.


RESULTS
Of 9 cases, 3 resulted in soft palate perforations, which required primary closure. The remaining 6 patients sustained a soft palate laceration, which was treated conservatively. This injury commonly occurs when the intubator is focused on the video monitor and blindly inserts the Glidescope into the oropharynx. The rigid stylet used with the Glidescope increases the propensity for oropharyngeal injuries during blind insertions.


CONCLUSIONS
Proper training, an awareness of this potential complication, and direct oral cavity visualization are recommended while inserting the videolaryngoscope. Repair is recommended for through-and-through perforations or if a large hanging flap is present. Antibiotics should be considered for lacerations greater than 1 to 2 cm.
1 Philadelphia College of Osteopathic Medicine, Otolaryngology-Head & Neck Surgery, Philadelphia, Pennsylvania, USA.
Quang
Q
Pham
1 Philadelphia College of Osteopathic Medicine, Otolaryngology-Head & Neck Surgery, Philadelphia, Pennsylvania, USA.
Mark
M
Lentner
2 Drexel University College of Medicine, Otolaryngology-Head & Neck Surgery, Philadelphia, Pennsylvania, USA.
Amanda
A
Hu
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000072700:Conservative Treatment; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D022125:Lacerations / Q000209:etiology* / Q000628:therapy; D020704:Laryngoscopes; D007828:Laryngoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D019647:Oral Surgical Procedures / Q000379:methods; D010160:Palate, Soft / Q000293:injuries*; D011183:Postoperative Complications / Q000209:etiology* / Q000628:therapy; D012189:Retrospective Studies; D014741:Video Recording; D020535:Video-Assisted Surgery / Q000009:adverse effects*
D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents
Glidescope; McGrath; palate; tonsil injury