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Technique to minimize cutting the nasoendotracheal tube during maxillary osteotomy
TECHNICAL NOTES J Oral Maxillofac 42:266-269.
Surg
1964
Technique to Minimize Cutting the Nasoendotracheal Tube During Maxillary Osteo tomy LOVEN LITCHMORE,
DMD,* and STEPHEN A. SACHS, DDSt
The total maxillary osteotomy has become essential for the definitive treatment of many dentofacial deformities. One disconcerting complication of this operation, however, is the inadvertent severing of the endotracheal tube during the lateral and midline nasal osteotomies.‘-4 To avoid this problem, we have modified the standard technique by eliminating the use of an osteotome for cutting the septum, and by sectioning the lateral nasal wall under direct vision.
era1 aspect of the nose bilaterally. With the nasal mucosa and tube protected by a thin malleable retractor, the lateral bony wall is cut approximately 1.5 cm posteriorly. Next, the cartilaginous nasal septum is elevated from the vomerine groove in the nasal crest of the maxilla. Firm downward and anterior pressure is then applied to the maxilla. Skin hooks secured to the nasal aperture are useful for this maneuver. The nasal septum is sectioned under direct vision using a large curved Mayo scissors (Fig. 1). The remaining nasal mucoperiosteum is carefully elevated. The remaining thin lateral walls of the nose may fracture during this procedure. If not, this is effected using a thin osteotome under direct vision. Finally, the vomer is divided by a straight Mayo scissors.
Technique The lateral, pterygoid and pyriform aperture oteotomies are performed in the usual manner. The mucoperiosteum is elevated from the floor and lat* Former Chief Resident.
Summary
t Chief. Received from the Division of Oral and Maxillofacial Surgery, Department of Dentistry, Long Island Jewish-Hillside Medical Center, New Hyde Park, New York 11042. Address correspondence and reprint requests to Dr. Sachs.
A modification of the standard maxillary osteotomy is suggested which minimizes the risks of
FIGURE I. Cutting of the nasal septum with Mayo scissors to avoid accidental cutting of the endotracheal tube.
268
severing the nasoendotracheal the nasal mucosa.
tube and lacerating
2. Pagar DM, Kupperman AW, Stem M: Cutting of nasoendotracheal tube: an unusual complication of maxillary osteotomies. J Oral Surg 36:314, 1978 3. Mosby EL, Messer EJ, Nealis MF, et al: Intraoperative damage to nasotracheal tubes during maxillary surgery: report of cases. J Oral Surg 36:963, 1978 4. Schwartz LB, Sordill WC, Liebers RM, et al: Difficulty in removal of accidentally cut endotracheal tube. J Oral Maxillofac Surg 40518, 1982
References 1. Fagraeus L, Angelillo JC, Dolan EA: A serious anesthesia hazard during orthognatic surgery. Anesth Analg (Cleve) 59: 150. 1980
J Oral Mmllofac 42.269.
Surg
1984
A Simple
Means of Maintaining Handle Sterility
Light
RICHARD S. SINGER, DDS,* and ALLEN L. SISK, DDSt
In the office practice of oral and maxillofacial surgery, one of the weakest links in the chain of sterility is the light handle. Since good visualization of the surgical field is very important to proper execution, adjustment of the operating light is often necessary. We have found heavy-duty aluminum foil to be a readily available and inexpensive material to use to maintain light handle sterility. Pieces of the foil can be cut to the desired size and placed in the instrument pack prior to sterilization. When
the surgeon is ready to begin the operation, the pieces can be quickly placed on the handle and the light is ready for adjustment (Fig. 1). Other means of light handle sterility have been reported. 1,2 However, use of the sterile aluminum foil offers some advantages over these methods. The foil requires no special attachments, it does not stick out from the light and increase the risk of being contaminated by the surgeon or assistant, it does not twist loose during certain light adjustments, and there is minimal risk of contaminating your hand or the sterile surface during placement. Also, it can be discarded at the end of the procedure so that no time is spent washing and sterilizing it for the next case.
* Former resident in Oral and Maxillofacial Surgery; now in private practice in Decatur, Georgia. t Assistant Professor. Received from the Department of Oral Surgery, Medical College of Georgia, Augusta, Georgia. Address correspondence and reprint requests to Dr. Singer: 5243 Snapfinger Woods Dr., Suite 106, Decatur, GA 30035.
Summary
The maintenance of sterility of the light handle in an economical and effective manner can be difficult. Heavy-duty aluminum foil is suggested as a simple and inexpensive material to be used to maintain such sterility in the clinical practice of oral and maxillofacial surgery. References
FIGURE handle.
1.
Heavy-duty
aluminum
1. Tolman DE: Modification of operating light: addition of removable handle for use during surgical procedures. J Oral Surg 31:3.53, 1973 2. Moeller DR, Spratt E: Modification of the operating light by addition of a removable sterile drape. J Oral Surg 40:62, 1982
foil in place on a light
269
Surg
1964
Technique to Minimize Cutting the Nasoendotracheal Tube During Maxillary Osteo tomy LOVEN LITCHMORE,
DMD,* and STEPHEN A. SACHS, DDSt
The total maxillary osteotomy has become essential for the definitive treatment of many dentofacial deformities. One disconcerting complication of this operation, however, is the inadvertent severing of the endotracheal tube during the lateral and midline nasal osteotomies.‘-4 To avoid this problem, we have modified the standard technique by eliminating the use of an osteotome for cutting the septum, and by sectioning the lateral nasal wall under direct vision.
era1 aspect of the nose bilaterally. With the nasal mucosa and tube protected by a thin malleable retractor, the lateral bony wall is cut approximately 1.5 cm posteriorly. Next, the cartilaginous nasal septum is elevated from the vomerine groove in the nasal crest of the maxilla. Firm downward and anterior pressure is then applied to the maxilla. Skin hooks secured to the nasal aperture are useful for this maneuver. The nasal septum is sectioned under direct vision using a large curved Mayo scissors (Fig. 1). The remaining nasal mucoperiosteum is carefully elevated. The remaining thin lateral walls of the nose may fracture during this procedure. If not, this is effected using a thin osteotome under direct vision. Finally, the vomer is divided by a straight Mayo scissors.
Technique The lateral, pterygoid and pyriform aperture oteotomies are performed in the usual manner. The mucoperiosteum is elevated from the floor and lat* Former Chief Resident.
Summary
t Chief. Received from the Division of Oral and Maxillofacial Surgery, Department of Dentistry, Long Island Jewish-Hillside Medical Center, New Hyde Park, New York 11042. Address correspondence and reprint requests to Dr. Sachs.
A modification of the standard maxillary osteotomy is suggested which minimizes the risks of
FIGURE I. Cutting of the nasal septum with Mayo scissors to avoid accidental cutting of the endotracheal tube.
268
severing the nasoendotracheal the nasal mucosa.
tube and lacerating
2. Pagar DM, Kupperman AW, Stem M: Cutting of nasoendotracheal tube: an unusual complication of maxillary osteotomies. J Oral Surg 36:314, 1978 3. Mosby EL, Messer EJ, Nealis MF, et al: Intraoperative damage to nasotracheal tubes during maxillary surgery: report of cases. J Oral Surg 36:963, 1978 4. Schwartz LB, Sordill WC, Liebers RM, et al: Difficulty in removal of accidentally cut endotracheal tube. J Oral Maxillofac Surg 40518, 1982
References 1. Fagraeus L, Angelillo JC, Dolan EA: A serious anesthesia hazard during orthognatic surgery. Anesth Analg (Cleve) 59: 150. 1980
J Oral Mmllofac 42.269.
Surg
1984
A Simple
Means of Maintaining Handle Sterility
Light
RICHARD S. SINGER, DDS,* and ALLEN L. SISK, DDSt
In the office practice of oral and maxillofacial surgery, one of the weakest links in the chain of sterility is the light handle. Since good visualization of the surgical field is very important to proper execution, adjustment of the operating light is often necessary. We have found heavy-duty aluminum foil to be a readily available and inexpensive material to use to maintain light handle sterility. Pieces of the foil can be cut to the desired size and placed in the instrument pack prior to sterilization. When
the surgeon is ready to begin the operation, the pieces can be quickly placed on the handle and the light is ready for adjustment (Fig. 1). Other means of light handle sterility have been reported. 1,2 However, use of the sterile aluminum foil offers some advantages over these methods. The foil requires no special attachments, it does not stick out from the light and increase the risk of being contaminated by the surgeon or assistant, it does not twist loose during certain light adjustments, and there is minimal risk of contaminating your hand or the sterile surface during placement. Also, it can be discarded at the end of the procedure so that no time is spent washing and sterilizing it for the next case.
* Former resident in Oral and Maxillofacial Surgery; now in private practice in Decatur, Georgia. t Assistant Professor. Received from the Department of Oral Surgery, Medical College of Georgia, Augusta, Georgia. Address correspondence and reprint requests to Dr. Singer: 5243 Snapfinger Woods Dr., Suite 106, Decatur, GA 30035.
Summary
The maintenance of sterility of the light handle in an economical and effective manner can be difficult. Heavy-duty aluminum foil is suggested as a simple and inexpensive material to be used to maintain such sterility in the clinical practice of oral and maxillofacial surgery. References
FIGURE handle.
1.
Heavy-duty
aluminum
1. Tolman DE: Modification of operating light: addition of removable handle for use during surgical procedures. J Oral Surg 31:3.53, 1973 2. Moeller DR, Spratt E: Modification of the operating light by addition of a removable sterile drape. J Oral Surg 40:62, 1982
foil in place on a light
269