Endotracheal tube anchoring to the maxilla in an edentulous patient with a facial burn

Abstract

Securing an endotracheal tube for the patients with facial blistering due to burns is problematic. Unstable fixation may cause dislodging of the tube. Various improvements have been reported to overcome this problem. However, they are not considered practical, because all methods require a special instrument, which may be impossible to obtain in emergent situations. In this report, we present a simple and easy technique to directly secure an endotracheal tube to the maxilla. A 64-year-old man sustained a scaled burn involving 10% of the total body surface area to the face and both hands. He also had inhalation injury and underwent immediate intra-tracheal intubation at a nearby hospital. As the patient's face was covered with blisters, the fixation of the tube to the skin was unstable. Also, the patient had no teeth to fix the tube. Thus, we directly fixed the endotracheal tube to the maxilla. A drill hole was made in the alveolar process of the maxilla using a Kirschner wire and hand-hold drilling instrument, and a nylon line was threaded through the hole and tied around the endotracheal tube. The tube was anchored securely until extubation for seven days. We describe a simple method to secure an endotracheal tube to the maxilla in a toothless patient who sustained facial burn, without any special instruments. Our procedure may be a favorable option for such patients who require immediate oral intubation.

Keywords

• emergent intubation
• endotracheal tube fixation
• facial burn
• inhalation injury
• maxilla
• toothless