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Breathing or ventilation via a mouth mask for rhinoplasty operations in the early postanaesthetic period

Erbay, H.; Kara, C. O.; Kara, I. G.; Tomatir, E.

Author Information
European Journal of Anaesthesiology: September 2003 - Volume 20 - Issue 9 - p 759

EDITOR:

Nasal packs are usually used to maintain haemostasis and stabilization of the reconstructed nose after rhinoplasty. Since the nostrils are completely blocked by the packs, breathing is only possible through the mouth once endotracheal extubation has taken place at the end of the operation. Compression of the fragile nose by a standard facemask could spoil the surgical result. Furthermore, immediately the endotracheal tube has been removed, breathing through a standard facemask is extremely difficult because the usual adult facemask is difficult to seal on the face due to the plaster splint and dressing.

Nagaro and colleagues developed a method to permit fibreoptic tracheal intubation in anaesthetized patients with ventilation performed only through the mouth [1]. They applied a child's mask over the mouth (mouth mask) instead of a standard anaesthesia adult facemask. In their method, an oral airway was usually inserted to overcome any airway obstruction and the nostrils were plugged with cotton if a leak through the nares occurred. Arai and colleagues reported that fibreoptic tracheal intubation could be achieved using a mouth mask in cases of difficult tracheal intubation [2]. They used the same method as Nagaro and colleagues [1], but used an infant's or child's mask, or else a specially constructed device, as a mouth mask. Arai and colleagues concluded that the mouth mask method for fibreoptic tracheal intubation was safe, useful and practical in instances of difficult intubation. After rhinoplasty operations, in the early postanaesthetic period, we have used a silicone child's mask through which the patient is permitted to breathe only through the mouth. We prefer a child's silicone facemask (No. 2 Silicone Child Mask, GaleMed Corp., I-Lan Hsien, Taiwan) as a mouth mask because of its elasticity and pliability over the mouth. The mask is applied only over the mouth; an oral airway is inserted to overcome any upper airway obstruction (Fig. 1). Patients breathed spontaneously through the child's mask in the operating room until they regained consciousness and their cognitive functions; standard monitoring, including pulse oximetry, was maintained in the recovery room. The same child's mask was used if supplemental oxygen was necessary. In our experience, breathing is much facilitated with a mouth mask compared with a standard anaesthesia mask in these patients; we have found it helpful on occasions to assist breathing. We have been using this method after rhinoplastic surgery for 1 yr and have found it easy and safe to use.

Figure 1
Figure 1:
Application of a mouth mask after rhinoplasty surgery.

H. Erbay

C. O. Kara

I. G. Kara

E. Tomatir

Departments of Anaesthesiology, Ear-Nose-Throat; Surgery, and Plastic and Reconstructive Surgery; Medicine Faculty, Pamukkale University, Denizli, Turkey

References

1. Nagaro T, Hamami G, Takasaki Y, Arai T. Ventilation via a mouth mask facilitates fiberoptic nasal tracheal intubation in anesthetized patients. Anesthesiology 1993; 78: 603-604.
2. Arai T, Nagaro T, Namba S, et al. Mouth mask method for fiberoptic tracheal intubation in difficult intubations. Masui 1996; 45: 244-248.
© 2003 European Academy of Anaesthesiology