Accidental Intubation of the Soft Palate

A 55-year-old man with a 20-year history of cigarette smoking presented with hoarseness and dysphagia for 6 months. On laryngoscopic examination, a left supraglottic submucosal mass was visible without vocal fold motion impairment. During a panendoscopy with biopsy under general anesthesia, a standard midline approach with the GlideScope video laryngoscope was used because of a history of previous C-spine surgery. A 7.5-mm endotracheal tube (ETT) was inserted into the oral cavity in the lateral position and then rotated anteriorly to be brought into view on the monitor. Shortly after the introduction of the endoscopic rigid laryngoscope, a small pool of blood collecting in the pharynx was noted. Careful inspection showed that the patient’s soft palate had been perforated during intubation (Figure 1). The surgery proceeded uneventfully, and the palatal defect was not repaired. When returned to the clinic for follow-up 8 days after surgery, complete closure of the palatal defect was found.

Figure 1.

The perforation is seen in right side of the soft palate.

Oropharyngeal injury is an unusual complication during intubation when performing videolaryngoscopy. ^1,2 The anesthesiologist’s visual attention may be detracted to the monitor while inserting the laryngoscope and ETT. This could lead to inadvertent trauma to the lips, teeth, tongue, and even pharynx. Once the soft palate has been perforated, problems with swallowing, mastication, and speech can develop, ³ although asymptomatic spontaneous healing occurred in our case. Careful ETT insertion with visual observation should prevent intraoral injury.