A Novel Tool to Prevent Endotracheal Tube Compression in Cleft Palate Surgery

Compression of endotracheal tube in palatopharyngeal surgery is an inherent problem. Many modifications of the Davis mouth gag have been used.1 The tongue blade has also undergone various modifications to prevent endotracheal tube compression. A slot and a middle groove have been incorporated to prevent the tube compression.2 This definitely reduced the magnitude of the problem. Later, Sommerlad extended the length of the slot almost to the base of the blade to avoid compression against the lower jaw.3 This caused herniation of the tube through the long slot and a piece of the sterile metal foil suture packet was placed over the tube before positioning the tongue blade.3 Agarwal et al,4 have incorporated two parallel bars over the lingual surface of the tongue blade. Although the free zone on lingual surface of tongue blade houses the lower lip, the problem of compression of endotracheal tube remains at the bending point at lip where the overlying tongue blade compressed the endotracheal tube against the teeth of lower jaw. To solve this problem we modified the connector portion of the endotracheal tube. We devised a small metal L-shaped tube and attached it to the outer end of the endotracheal tube (figure 1). The other end of the metal tube was attached to the tubing of the anaesthesia machine. This metal tube is placed over the lower teeth area. The tongue blade was placed over this area (figure 2), thus avoiding any compression at the lower teeth area. We fixed the tube to the lower dentition with 27° French dental wire or silk. The packing of the throat with soaked gauze was ensured in all the cases. We used this modification in over 150 patients undergoing palatopharyngeal and intra-oral surgery over three years. We did not encounter any case of tube compression.