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Le Fort I osteotomy facilitated nasotracheal intubation in a patient with concha bullosa and septal deviation: a case report

  • Je Jin Lee1
  • Geun Joo Choi1
  • Hyun Kang1
  • Chong Wha Baek1
  • Su Hyun Seo1
  • Young-Jun Choi2
  • Ui-Lyong Lee3
  • Yong Hun Jung1

1Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, 84, Heukseok-ro, Dongjak-gu, 06974 Seoul, Republic of Korea

2Department of Oral & Maxillofacial Surgery, Chung-Ang University College of Medicine, 84, Heukseok-ro, Dongjak-gu, 06974 Seoul, Republic of Korea

3Department of Oral & Maxillofacial Surgery, Dental Center, Chung-Ang University Hospital, 102, Heukseok-ro, Dongjak-gu, 06973 Seoul, Republic of Korea

DOI: 10.22514/sv.2021.062 Vol.17,Issue 3,May 2021 pp.238-241

Submitted: 31 December 2020 Accepted: 09 March 2021

Published: 08 May 2021

*Corresponding Author(s): Yong Hun Jung E-mail:


Introduction: Nasotracheal intubation (NTI) is preferred for general anesthesia in maxillofacial surgery. However, NTI is often traumatic or even unsuccessful, particularly in patients with a narrow nasal pathway. In this case report, we describe a less traumatic NTI approach using maxillary downfracture of Le Fort I osteotomy.

Case presentation: A 19-year-old woman was admitted with a skeletal Class III malocclusion and scheduled to undergo bimaxillary orthognathic surgery. A preoperative evaluation revealed no other medical history and abnormal laboratory findings. Preoperative computed tomography showed nasal septal deviation, concha bullosa, and turbinate hypertrophy. A nasal Ring-Adair-Elwyn endotracheal tube and a tube exchanger could not be inserted via NTI because of her narrow nasal cavity. An oral intubation was performed temporarily and surgery was started. After a maxillary downfracture was performed, which made the nasal cavity wider than before, NTI was successfully conducted without difficulty. The patient was ventilated without any problems, and the operation was continued. Postoperatively, the patient had no further complications and her vital parameters were all stable.

Conclusions: This case report suggests that NTI after maxillary downfracture of Le Fort I osteotomy can be a good alternative that can be successfully performed with less trauma in patients undergoing orthognathic surgery who are preoperatively evaluated as having a narrow nasal cavity.


Nasotracheal intubation; Maxillary downfracture; Orthognathic surgery; Case report

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Je Jin Lee,Geun Joo Choi,Hyun Kang,Chong Wha Baek,Su Hyun Seo,Young-Jun Choi,Ui-Lyong Lee,Yong Hun Jung. Le Fort I osteotomy facilitated nasotracheal intubation in a patient with concha bullosa and septal deviation: a case report. SignaVitae. 2021. 17(3);238-241.


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