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| STUDENTS CORNER |
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| Year : 2011 | Volume
: 1
| Issue : 2 | Page : 75-76 |
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Nasal intubation of microlaryngeal tracheal tube for vocal cord lesion surgery
Anurag Gupta
Department of Anesthesia, Dr. RML Hospital and PGIMER, New Delhi - 01, India
| Date of Web Publication | 19-Sep-2011 |
Correspondence Address:
Anurag Gupta
Dr. RML Hospital and PGIMER, New Delhi - 01
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/2230-9748.85069
 Abstract | | |
Microlaryngeal tracheal (MLT) tube, when inserted through nasal route, offers adequate space in front of the tube for proper vision, excision and hemostasis of vocal cord lesions in the anterior and middle third portions as compared to oral route. There is less risk of kinking of tube at the point of securing with skin and it provides easy instrumentation for exposure of oral cavity. MLT tube placed nasally lies in the posterior comissure of vocal cord between arytenoids, leaving anterior two-third or more unobscured. Keywords: Microlaryngeal tracheal tube, nasal intubation, vocal cord lesion
How to cite this article:
Gupta A. Nasal intubation of microlaryngeal tracheal tube for vocal cord lesion surgery. J Laryngol Voice 2011;1:75-6 |
| Introduction | |  |
Vocal cord lesions are common pathologies and their management often requires microlaryngeal surgery and excision for biopsy followed by further management. Patients posted for such surgery require general anesthesia which is conventionally administered using endotracheal tube to protect the airway, provide respiratory gas exchange and to provide immobility of vocal cords. [1] Undoubtedly, there are newer methods of providing anesthesia like jet ventilation which may improve access further, but conventional endotracheal intubation remains the main anesthetic technique in microlaryngeal surgery. Also, in other techniques, there may be chances of barotrauma, carbon dioxide build up and reduced protection of airway. In this communication, I would like to share my experience in nasally intubating such cases with MLT tube for providing anesthesia.
During microlaryngeal surgeries, there is a need to share a common space for providing anesthesia and surgical access. Space around the lesion is also an important factor for proper vision, excision and hemostasis during surgery. The correct placement of a microlaryngeal tracheal (MLT) tube is important and can make a difference in the outcome of the procedure. MLT tubes are specialized endotracheal tubes with standard tube length and cuff size, but with reduced outer and inner diameter. This allows for improvement in the operative area in view of access and excision of the lesion. In cases where the lesion involves the anterior half of vocal cord, it is seen that the MLT tube lies in the posterior commissure when it has been introduced through the nose in comparison to the oral route. Such cases are of course taken after ruling out any contraindication and risk associated with nasal intubation. MLT tube, when inserted nasally, lies between arytenoids, leaving anterior two-third or more unobscured. [2] Also, nasal tubes are smaller than normal oral endotracheal tube and occupy less chink.
MLT tube, being much smaller in outer diameter compared to the standard endotracheal tube, when inserted through nasal route, offers adequate space in front of the tube for proper vision, excision and hemostasis as compared to its insertion through oral route. Also, there is less risk of kinking of tube at the point of securing it with skin, along with the provision of easy instrumentation for exposure of oral cavity. MLT placed nasally lies in the posterior comissure of vocal cord because of the natural elasticity of the tube and secondly the soft palate pushes the tube more posterior when it comes out from posterior choanas. Nevertheless, oral intubation is much easier [3] and nasal intubation carries the inherent risk of bleeding and the procedure requires more expertise. In my limited experience as a student, I have observed that in patients with lesion in the anterior half of vocal cord, it is beneficial to nasally intubate the patient for microlaryngeal surgery.
| References | | |
| 1. | Keen RI, Kotak PK, Ramsden RT. Anaesthesia for microsurgery of the larynx. Ann R Coll Surg Engl 1982;64:111-3. 
[PUBMED] [FULLTEXT] |
| 2. | Coplans MP. A cuffed nasotracheal tube for microlaryngeal surgery. Anaesthesia 1976;31:430-2.
[PUBMED] |
| 3. | Holzapfel L. Nasal vs oral intubation. Minerva Anestesiol 2003;69:348-52.
[PUBMED] [FULLTEXT] |
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