To the Editor.—
Aronchick et al1 provided a useful discussion of complications related to malpositioned nasoenteric and nasogastric tubes. However, their review of the "few published reports" of this problem only cited injury to the pharynx, esophagus, tracheobronchial tree, and the rest of the upper gastrointestinal tract. They did not mention perhaps the most serious complications of such tubes: intracranial penetration.
Bouzarth2 reviewed five reported cases of intracranial penetration of a nasogastric tube. Each occurred after severe maxillofacial trauma. Four of the five patients died, although the extent of their injuries made it impossible to determine the degree to which the malpositioned tube contributed to the fatal outcome.
The authors of these reports variously recommend that when extensive maxillofacial trauma occurs, nasogastric intubation should be performed only under direct endoscopic visualization, or through a precurved nasopharyngeal airway. Alternatively, gastric intubation through the oral cavity should be performed, also
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