Submucous dissection of the nasopharynx complicating nasotracheal intubation

Abstract

We present the case of a 60-year old woman, who had an unusual complication of nasotracheal intubation, which was carried out to relieve post-thyroidectomy respiratory distress at the University of Ilorin Teaching Hospital (UITH). She presented with a huge malignant goitre complicated by severe respiratory distress due to pressure symptoms and left vocal cord palsy. An emergency near total thyroidectomy was done under endotracheal general anaesthesia. Respiratory distress persisted after thyroidectomy and tracheal extubation. A nasotracheal tube was subsequently passed. On the fourth postoperative day, she developed another episode of severe respiratory distress due to endotracheal tube blockage. Her trachea was extubated but attempts to re-introduce the tube through the nasal route were unsuccessful but instead resulted in submucous dissection of the nasopharynx. An emergency tracheostomy was subsequently performed.