246 Section VI ■ Respiratory Care

e. Mucosal necrosis (Fig. 36.15)

f. Vocal cord injuries

g. Dislocation of arytenoid

2. Chronic trauma (23–25)

a. Cricoid ulceration and fibrosis

b. Glottic and/or subglottic stenosis (Fig. 36.15)

c. Subglottic granuloma (Figs. 36.16 and 36.17)

d. Hoarseness, stridor, wheezing

e. Subglottic cyst

f. Tracheomegaly

g. Protrusion of laryngeal ventricle

3. Interference by oral tube with oral development

(7,8,26,27)

a. Alveolar grooving

b. Palatal grooves (Fig. 36.18)

c. Acquired oral commissure defect (Fig. 36.19)

d. Posterior cross-bite

e. Defective dentition

(1) Enamel hypoplasia

(2) Incisor hypoplasia

f. Poor speech intelligibility

4. Local effects from nasal tube (28–30)

a. Erosion of nasal septum

b. Stenosis of nasal vestibule (Fig. 36.20)

Fig. 36.17. Glottic granuloma after intubation. Epiglottis is

manually retracted to reveal granuloma below cords. Esophageal

opening is clearly visible beneath airway.

Fig. 36.16. Radiographic magnification high-kilovoltage film

(×2) demonstrating an abrupt cutoff of the right bronchus intermedius (arrow) due to an endobronchial granuloma, with secondary volume loss at the right lung base. Although these granulomas

may be due to endotracheal tube trauma, in this area they are

more likely related to suction tube injury. The endotracheal tube

is just entering the right bronchus.

c. Nasal congestion

d. Midfacial hypoplasia

e. Otitis media

5. Systemic side effects (31,32)

a. Infection

b. Aspiration

Fig. 36.15. Subglottic erosion and stenosis after intubation.