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Purpose@#Intrahepatic cholangiocarcinoma (ICC) has various characteristics according to anatomical, histologic classifications, and its prognoses are different. This study aimed to compare oncologic outcomes according to tumor location (second bile duct confluence) and evaluate the effect of adjuvant chemotherapy. @*Methods@#Clinical data of 318 patients who underwent curative resection for ICC was reviewed. Central type ICC (C-ICC) and peripheral type ICC (P-ICC) were defined when the tumor invades the intrahepatic secondary biliary confluence and when located more peripherally, respectively. @*Results@#A larger tumor size, higher rate of elevated CA 19-9 level, vascular invasion, R1 resection, advanced T stage, and lymph node metastasis were found in C-ICC. C-ICC had poorer overall survival (median, 33 months vs. 58 months; P = 0.001), and the difference was more prominent in the early stage. C-ICC had a higher recurrence rate (68.7% vs. 55.1%, P = 0.014); otherwise, there was no difference in the recurrence patterns. There were no survival benefits of adjuvant chemotherapy in the entire cohort, but there were benefits in advanced stages (T3–4, N1 stage), especially in C-ICC. @*Conclusion@#C-ICC has more aggressive tumor characteristics and poor survival compared to P-ICC. Adjuvant chemotherapy seems to have survival benefits in the advanced stages, especially in the central type.
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Purpose@#As pancreaticojejunostomy (PJ) is a challenging anastomosis, an education program is needed to train young surgeons to perform PJ. This study evaluated the effects of simulation-based training of open PJ using pancreas and intestine silicone models. @*Methods@#Five videos pancreatobiliary clinical fellows who did not perform PJ participated in this study. After watching the master video created by a senior pancreatobiliary surgeon, each trainee performed the PJ using silicone models and recorded them 10 times using a video camera. Of these videos, 5 were randomly duplicated due to the validation of the scoring system. The scoring system developed consisted of 20 scores. Three pancreatobiliary professors scored their performance by watching videos. @*Results@#The mean procedure time of the 5 trainees was 25.4 minutes (range, 23.5–27.3 minutes) in the first video and 15.8 minutes (range, 13.8–19.1 minutes) in the 10th video. The mean score was 12.6 (range, 5–19) and 18.3 (range, 15–20) in the first and 10th videos, respectively. The scores were similar among the duplicated videos for each supervisor. @*Conclusion@#This education system would help pancreatobiliary trainees to overcome learning curves efficiently without ethical issues related to animal models or direct practice to human patients.
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Purpose@#The measurement of stool elastase (SE) level is useful for evaluating pancreatic exocrine function. This study aimed to determine the risk factors for severe exocrine pancreatic insufficiency (EPI) after pancreatoduodenectomy (PD), and analyze serial changes in nutritional markers and weight based on the SE level. @*Methods@#Among patients who underwent PD for periampullary disease, patients whose preoperative and postoperative SE levels were measured were included in the study. The deteriorated (exocrine function) group comprised patients whose SE levels decreased from ≥100 µg/g preoperatively to <100 µg/g postoperatively. Patients whose weight 12 months postoperatively was greater than that 3 months postoperatively were classified into the weight-recovery group. @*Results@#Of the 202 included patients, the deteriorated group had a higher incidence of preoperative SE level above 200 μg/ g, benign pathology, and the presence of a clinically relevant postoperative pancreatic fistula than the maintained group. Patients who did not undergo weight recovery had a higher rate of history of adjuvant radiotherapy compared to the norecovery group. @*Conclusion@#The evaluation of EPI by measuring SE alone is not sufficient because it does not reflect the nutritional status of patients, and a comprehensive approach that considers other parameters is required for EPI management.
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Purpose@#Although serum CEA and CA 19-9 have been widely utilized for the diagnosis of gallbladder cancer (GBC), few studies have examined the diagnostic performance of them. This study aimed to investigate the diagnostic performance of these 2 biomarkers and demonstrate their clinical usefulness in diagnosing GBC. @*Methods@#Between January 2000 and March 2020, a total of 751 GBC patients and 2,310 normal controls were included. Serum CEA and CA 19-9 were measured preoperatively. Receiver operating characteristic curves were obtained, and the sensitivity and specificity of each biomarker were evaluated. @*Results@#In terms of differentiating GBC from the control, the sensitivity and specificity of serum CEA at 5 ng/mL was 12.1% and 99.1%, respectively, and those of serum CA 19-9 at 37 IU/mL were 28.7% and 94.5%, respectively. The optimal cutoff values of CEA and CA 19-9 were set to 2.1 ng/mL and 26 IU/mL in the receiver operating characteristic curves, respectively.The sensitivities of CEA and CA 19-9 at new cutoff values slightly increased but remained low (CEA, 42.9%; CA 19-9, 38.2%). When differentiating early-stage GBC from advanced tumor, the sensitivity and specificity, were 14.2% and 96.1% for CEA (cutoff value, 5 ng/mL) and 33.6% and 90.1% for CA 19-9 (cutoff value, 37 IU/mL), respectively. @*Conclusion@#Serum CEA and CA 19-9 levels are not suitable for screening GBC patients from controls. New promising biomarkers with higher sensitivity should be explored.
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Purpose@#There are few reports of postoperative long-term malignant risk or postoperative sequelae after surgery for choledochal cysts (CCs). This study aimed to analyze the clinical characteristics of patients with malignancy and the longterm results of operated CC. @*Methods@#The patients who underwent surgical treatments for CC between 2003 and 2020 at Seoul National University Hospital were enrolled. Clinicopathologic factors and pre-/postoperative computed tomography or magnetic resonance imaging were reviewed. @*Results@#Of the 153 patients, Todani classification Ic (36.6%), C-P type (43.8%) anomalous pancreaticobiliary duct union were the most common type respectively. Fourteen patients (9.2%) had biliary tract cancer and a comparison of patients with and without malignancy showed that the diameter of cyst was significantly lower in malignant patients and malignancy was observed to be significantly higher in P-C type. The incidence of long-term complications was 9.8%, and the median time interval was 30 months. The 2 most common complications were cholangitis and stricture (60.0%). There was one case of new cancer near the intrapancreatic remnant bile duct. @*Conclusion@#Of the resected CCs, 9.2% had a combined malignancy on the biliary tracts. Long-term complications such as cholangitis, anastomotic stricture, and new cancers may occur. Therefore, continuous surveillance is required.
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Background/Aims@#Although many studies have reported the promising effect of neoadjuvant treatment for borderline resectable pancreatic cancer (BRPC) to increase resectability, only a few studies have recommended the use of first-line chemotherapeutic agents as neoadjuvant treatment for BRPC. The current study compared clinical outcomes between gemcitabine and FOLFIRINOX (5-fluorouracil, leucovorin, oxaliplatin, and irinotecan) in patients with BRPC. @*Methods@#In this single-center retrospective study, 100 BRPC patients treated with neoadjuvant chemotherapy and resection from 2008 to 2018 were reviewed. Clinical outcomes included overall survival, resectability, and recurrence patterns after gemcitabine or FOLFIRINOX treatment. @*Results@#For neoadjuvant chemotherapy, gemcitabine was administered to 34 patients and FOLFIRINOX to 66. Neoadjuvant radiotherapy was administered to 27 patients (79.4%) treated with gemcitabine and 19 (28.8%) treated with FOLFIRINOX (p<0.001). The 2- and 5-year survival rates (YSRs) were significantly higher after FOLFIRINOX (2YSR, 72.2%; 5YSR, 46.0%) than after gemcitabine (2YSR, 58.4%; 5YSR, 19.1%; p=0.041). The margin negative rate was comparable (gemcitabine, 94.1%; FOLFIRINOX, 92.4%; p=0.753), and the tumor size change in percentage showed only a marginal difference (gemcitabine, 20.5%; FOLFIRINOX, 29.0%; p=0.069). Notably, the metastatic recurrence rate was significantly lower in the FOLFIRINOX group (n=20, 52.6%) than in the gemcitabine group (n=22, 78.6%; p=0.001). The rate of adverse events after chemotherapy was significantly higher with FOLFIRINOX than with gemcitabine (43.9%, 20.6%, respectively; p=0.037). @*Conclusions@#FOLFIRINOX provided more clinical and oncological benefit than gemcitabine, with significantly higher overall survival and lower cumulative recurrence rates in BRPC. However, since FOLFIRINOX causes more adverse effects, the regimen should be individualized based on patient’s general condition and clinical status.
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Background/Aims@#Although many studies have reported the promising effect of neoadjuvant treatment for borderline resectable pancreatic cancer (BRPC) to increase resectability, only a few studies have recommended the use of first-line chemotherapeutic agents as neoadjuvant treatment for BRPC. The current study compared clinical outcomes between gemcitabine and FOLFIRINOX (5-fluorouracil, leucovorin, oxaliplatin, and irinotecan) in patients with BRPC. @*Methods@#In this single-center retrospective study, 100 BRPC patients treated with neoadjuvant chemotherapy and resection from 2008 to 2018 were reviewed. Clinical outcomes included overall survival, resectability, and recurrence patterns after gemcitabine or FOLFIRINOX treatment. @*Results@#For neoadjuvant chemotherapy, gemcitabine was administered to 34 patients and FOLFIRINOX to 66. Neoadjuvant radiotherapy was administered to 27 patients (79.4%) treated with gemcitabine and 19 (28.8%) treated with FOLFIRINOX (p<0.001). The 2- and 5-year survival rates (YSRs) were significantly higher after FOLFIRINOX (2YSR, 72.2%; 5YSR, 46.0%) than after gemcitabine (2YSR, 58.4%; 5YSR, 19.1%; p=0.041). The margin negative rate was comparable (gemcitabine, 94.1%; FOLFIRINOX, 92.4%; p=0.753), and the tumor size change in percentage showed only a marginal difference (gemcitabine, 20.5%; FOLFIRINOX, 29.0%; p=0.069). Notably, the metastatic recurrence rate was significantly lower in the FOLFIRINOX group (n=20, 52.6%) than in the gemcitabine group (n=22, 78.6%; p=0.001). The rate of adverse events after chemotherapy was significantly higher with FOLFIRINOX than with gemcitabine (43.9%, 20.6%, respectively; p=0.037). @*Conclusions@#FOLFIRINOX provided more clinical and oncological benefit than gemcitabine, with significantly higher overall survival and lower cumulative recurrence rates in BRPC. However, since FOLFIRINOX causes more adverse effects, the regimen should be individualized based on patient’s general condition and clinical status.
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Robotic single-site cholecystectomy (RSSC) has emerged as an alternative procedure to overcome the shortcomings of single-fulcrum laparoscopic cholecystectomy in terms of the ergonomics and reducing the physical and mental stress of the surgeon. It is also necessary to assess the safety of RSSC for obese patients in a world with an increasing population of obese people. RSSC took a longer operation time, but the actual dissection time was similar to that of single-fulcrum laparoscopic cholecystectomy. There was no difference in postoperative pain, except for during the immediate postoperative period, and in the length of the hospital stay. RSSC had the advantage of reducing the incidence of intraoperative iatrogenic gallbladder perforation. It is critical to prevent any intraoperative bile leakage, which is associated as a worse prognostic factor in those patients with gallbladder cancer. Additional studies with a prospective design and larger number of study subjects will be required to confirm the safety and feasibility of RSSC. Moreover, the cost benefit and safety for treating malignant lesions are also issues to be addressed. RSSC is expected to be further expanded as an operative mode in the future.
Subject(s)
Humans , Bile , Cholecystectomy , Cholecystectomy, Laparoscopic , Cost-Benefit Analysis , Gallbladder , Gallbladder Neoplasms , Ergonomics , Incidence , Laparoscopy , Length of Stay , Obesity , Pain, Postoperative , Postoperative Period , Prospective Studies , Robotic Surgical ProceduresABSTRACT
PURPOSE: Robotic-associated minimally invasive surgery is a novel method for overcoming some limitations of laparoscopic surgery. This study aimed to evaluate the outcomes (postoperative pain, cosmesis, surgeon's workload) of single-incision robotic cholecystectomy (SIRC) vs. single-incision laparoscopic cholecystectomy (SILC) vs. conventional three-port laparoscopic cholecystectomy (3PLC). METHODS: 134 patients who underwent laparoscopic or robotic cholecystectomy at a single center during 2016~2017 were enrolled. Prospectively collected data included demographics, operative outcomes, questionnaire regarding pain and cosmesis, and NASA-Task Load Index (NASA-TLX) scores for surgeon's workload. RESULTS: 55 patients underwent SIRC, 29 SILC, and 50 3PLC during the same period. 3PLC patient group was older than the others (SIRC vs. SILC vs. 3PLC: 48.1 vs. 42.2 vs. 54.1 years, p < 0.001). Operative time was shortest with 3PLC (44.1 vs. 38.8 vs. 25.4 min, p < 0.001). Estimated blood loss, postoperative complications, and postoperative stay were similar among the groups. Pain control was lowest in the 3PLC group (98.2% vs. 100% vs. 84.0%, p=0.004), however, at 2 weeks postoperatively there were no differences among the groups (p=0.374). Cosmesis scores were also worst after 3PLC (17.5 vs. 18.4 vs. 13.3, p < 0.001). NASA-TLX score was highest in the SILC group (21.9 vs. 44.3 vs. 25.2, p < 0.001). CONCLUSION: Although SIRC and SILC take longer than 3PLC, they produce superior cosmetic outcomes. Compared with SILC, SIRC is more ergonomic, lowering the surgeon's workload. Despite of higher cost, SIRC could be an alternative for treating gallbladder disease in selected patients.
Subject(s)
Humans , Body Image , Cholecystectomy , Cholecystectomy, Laparoscopic , Demography , Gallbladder Diseases , Laparoscopy , Methods , Minimally Invasive Surgical Procedures , Operative Time , Pain, Postoperative , Postoperative Hemorrhage , Prospective StudiesABSTRACT
PURPOSE: Neoadjuvant treatment may provide improved survival outcomes for patients with borderline resectable pancreatic cancer (BRPC). The purpose of this study is to evaluate the clinical outcomes of neoadjuvant treatment and to identify prognostic factors. METHODS: Forty patients who met the National Comprehensive Cancer Network definition of BRPC and received neoadjuvant treatment followed by surgery between 2007 and 2015 were evaluated. Prospectively collected clinicopathological outcomes were analyzed retrospectively. RESULTS: The mean age was 61.7 years and the male-to-female ratio was 1.8:1. Twenty-six, 3, and 11 patients received gemcitabine-based chemotherapy, 5-fluorouracil, and FOLFIRINOX, respectively. The 2-year survival rate (2YSR) was 36.6% and the median overall survival (OS) was 20 months. Of the 40 patients, 34 patients underwent resection and the 2YSR was 41.2% while the 2YSR of patients who did not undergo resection was 16.7% (P = 0.011). The 2YSR was significantly higher in patients who had partial response compared to stable disease (60.6% vs. 24.3%, P = 0.038), in patients who did than did not show a CA 19-9 response after neoadjuvant treatment (40.5% vs. 0%, P = 0.039) and in patients who did than did not receive radiotherapy (50.8% vs. 25.3%, P = 0.036). Five patients had local recurrence and 17 patients had systemic recurrence with a median disease specific survival of 15 months. CONCLUSION: Neoadjuvant treatment followed by resection is effective for BRPC. Pancreatectomy and neoadjuvant treatment response may affect survival. Effective systemic therapy is needed to improve long-term survival since systemic metastasis accounts for a high proportion of recurrence.
Subject(s)
Humans , Drug Therapy , Fluorouracil , Neoadjuvant Therapy , Neoplasm Metastasis , Pancreatectomy , Pancreatic Neoplasms , Prognosis , Prospective Studies , Radiotherapy , Recurrence , Retrospective Studies , Survival RateABSTRACT
PURPOSE: Patients usually suffer from pain and discomfort after oral surgery and their consumption of food is severely affected. Accordingly, the patients' quality of life reduce significantly. The aim of this study was to analyze patient satisfaction on the nutritional supplement drinks following periodontal surgery. MATERIALS AND METHODS: Total 90 patients who underwent periodontal surgery were recruited and commercially available nutritional drinks were provided. Group I received two bottles per each meal for 2 days, Group II had one bottle per each meal for 3 days, and Group III had no drinks. The survey for the patient-reported outcome measures (PROMs) were given at the next visit for the removal of sutures. RESULTS: The result of PROMs showed the nutrition drink was easy to intake, appeared to help the healing and can be a satisfying supplement for the meals. CONCLUSION: Nutritional drinks appeared to help the healing after periodontal surgeries and supported the food intake. Also, it was helpful for the patients in nutritional supply and psychological stability.
Subject(s)
Humans , Eating , Meals , Outcome Assessment, Health Care , Patient Satisfaction , Quality of Life , Surgery, Oral , Sutures , Wound HealingABSTRACT
Biliary enteric fistula is an abnormal pathway often caused by biliary disease. It is difficult to diagnose the disease because patients have nonspecific symptoms. A 67-year-old woman presented with hematemesis and melena. She was diagnosed with Dieulafoy lesion on the gastric antrum and underwent endoscopic hemostasis using hemoclips. Follow-up upper gastrointestinal endoscopy revealed an abnormal opening on a previous treated site that was suggestive of biliary enteric fistula. Abdomen simple X-ray and abdominal dynamic CT scan showed pneumobilia and cholecysto-gastric fistula. The patient had cholecystectomy and wedge resection of the gastric antrum, followed by right extended hemicolectomy because of severe adhesive lesion between the gallbladder and colon. She was diagnosed with cholecysto-gastro-colic fistula postoperatively. We report on this case and give a brief review of the literatures.
Subject(s)
Aged , Female , Humans , Biliary Fistula/complications , Cholecystectomy , Endoscopy, Gastrointestinal , Gastric Fistula/complications , Gastrointestinal Hemorrhage/complications , Intestinal Fistula/complications , Tomography, X-Ray ComputedABSTRACT
Hyperphosphatemia develops when there is impaired renal phosphate excretion or massive extracellular fluid phosphate load. For example, renal insufficiency, hypoparathyroidism, exogenous phosphate administration, and extensive cellular injury induce a hyperphosphatemic state. In patients with multiple myeloma, renal insufficiency occurs as a result of hypercalcemia, light chain tubulopathy, urate nephropathy or infection, and hyperphosphatemia usually results from renal failure. We report here a case of a patient with multiple myeloma who had an elevated serum phosphate level measured by the phosphomolybdate UV method without significant renal insufficiency and was finally diagnosed with pseudohyperphosphatemia.
Subject(s)
Humans , Extracellular Fluid , Hypercalcemia , Hyperphosphatemia , Hypoparathyroidism , Light , Molybdenum , Multiple Myeloma , Phosphoric Acids , Renal Insufficiency , Uric AcidABSTRACT
Emphysematous gastritis is a subtype of phlegmonous gastritis characterized by emphysematous change of the gastric wall. It is associated with infection of gas forming organism and is often fatal because of suppurative bacterial infection. Streptococci is the most commonly involved microorganism of emphysematous gastritis. Aspergillus is a very rare pathogen of this disease, because invasive aspergillosis often presents as pulmonary infections and rarely involves the gastro-intestinal tract. Treatment should be aimed to cover various organism using broad spectrum antibiotics, and sometimes aggressive surgical management may be needed to enhance survival. We report a case of severe emphysematous gastritis caused by invasive aspergillosis with a review of the literature.
Subject(s)
Anti-Bacterial Agents , Aspergillosis , Aspergillus , Bacterial Infections , Cellulitis , GastritisABSTRACT
Emphysematous gastritis is a subtype of phlegmonous gastritis characterized by emphysematous change of the gastric wall. It is associated with infection of gas forming organism and is often fatal because of suppurative bacterial infection. Streptococci is the most commonly involved microorganism of emphysematous gastritis. Aspergillus is a very rare pathogen of this disease, because invasive aspergillosis often presents as pulmonary infections and rarely involves the gastro-intestinal tract. Treatment should be aimed to cover various organism using broad spectrum antibiotics, and sometimes aggressive surgical management may be needed to enhance survival. We report a case of severe emphysematous gastritis caused by invasive aspergillosis with a review of the literature.
Subject(s)
Anti-Bacterial Agents , Aspergillosis , Aspergillus , Bacterial Infections , Cellulitis , GastritisABSTRACT
Bisphosphonate generally seems to be safe, but hypocalcemia may occasionally develop in the course of bisphosphonate treatment. Hypocalcemia induced by bisphosphonate is usually mild and asymptomatic, but unrecognized or poorly treated hypocalcemia can lead to life-threatening state. A 78-year-old woman who had a history of hip arthroplasty and intravenous zoledronate treatment for femur neck fracture was presented to emergency department with altered mental status. It turned out that her symptom was due to severe hypocalcemia which was caused by intravenous zoledronate treatment. She also had renal dysfunction. She was treated by intravenous calcium gluconate and calcitriol administration. This case supports the need for evaluation of renal dysfunction, vitamin D deficiency and parathyroid gland dysfunction before bisphosphonate treatment and accurate monitoring of plasma calcium and creatinine levels. In addition, vitamin D and calcium supply during treatment with bisphosphonate is mandatory.
Subject(s)
Aged , Female , Humans , Arthroplasty , Calcitriol , Calcium , Calcium Gluconate , Creatinine , Diphosphonates , Emergencies , Femoral Neck Fractures , Gluconates , Hip , Hypocalcemia , Imidazoles , Osteoporosis , Parathyroid Glands , Plasma , Vitamin D , Vitamin D DeficiencyABSTRACT
Neurilemmoma is a benign and slowly growing neurogenic tumor. Intrathoracic neurilemmoma often develops in the chest wall and posterior mediastinum, but endobronchial neurilemmoma is extremely rare. The diagnosis of endobronchial neurilemmoma with preoperative imaging findings is challenging and is usually made via postoperative pathological examination. These authors encountered a case of primary endobronchial neurilemmoma in a 52-year-old woman who had no symptoms. A 3.0 x 2.6 cm mass in the right lower lobe projecting into the mediobasal segmental bronchus was shown in the results of the contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) of the chest. Benign neurilemmoma was confirmed via bronchoscopic biopsy, and surgical resection (sleeve bronchial excision and end-to-end anastomosis) was performed.
Subject(s)
Female , Humans , Middle Aged , Biopsy , Bronchi , Magnetic Resonance Imaging , Mediastinum , Neurilemmoma , Pulmonary Surgical Procedures , Thoracic Wall , ThoraxABSTRACT
Primary malignant lymphoma of the stomach comprises 1 to 7% of all gastric malignancies and is mostly B-cell type. Anaplastic large cell lymphoma (ALCL) of the stomach is very rare and regarded to have a poor prognosis. A 66-year-old man complained of dyspepsia for 3 days. A esophagogastroduodenoscopic examination revealed a flat, depressed ulcer at the distal antrum. Biopsy of the lesion showed diffuse infiltration of large pleomorphic lymphoid cells that were positive for CD3 and CD30 and negative for cytokeratin and anaplastic lymphoma kinase (ALK). We diagnosed the patient with ALK-negative primary gastric ALCL with multiple lymphadenopathies, and he received systemic chemotherapy. CHOP-like regimens followed by consolidation therapy have been widely used for ALK-negative ALCL. However, the patient maintained complete remission for 36 months with only induction chemotherapy. This case suggests that heavy treatment for ALK-negative ALCL is not required for all patients.
Subject(s)
Aged , Humans , B-Lymphocytes , Biopsy , Dyspepsia , Induction Chemotherapy , Keratins , Lymphocytes , Lymphoma , Lymphoma, Large-Cell, Anaplastic , Phosphotransferases , Prognosis , Receptor Protein-Tyrosine Kinases , Stomach , UlcerABSTRACT
BACKGROUND: After burn patients are discharged from the hospital, they may continue to feel pain and paresthetic sensations at the site of a healed burn and these problems may persist for years. This study was designed to describe the characteristics of these symptoms in terms of intensity, frequency, and influencing factors. METHODS: Patients that developed paresthetic sensations at sites of a healed burn were recruited from the pain management center from January 2003 to April 2006. Data was collected using a structured interview protocol. RESULTS: Fifty one adults, with a total body surface area burned (TBSA) of 21.1 +/- 16.3% aged 42.0 +/- 12.9 years were studied. A paresthetic sensation was reported to be present every day in 52.9% (27/51) of the subjects. A variation in the intensity was most commonly related to changes in the weather. A tight sensation and itching types of sensations were significantly more frequent in patients with more extensive injuries. CONCLUSIONS: Recognition and understanding of the chronic paresthetic sensation that many burn patients continue to experience at sites of a healed burn deserve further attention. Not only do clinicians need to be aware of these problems but also strategies for prevention and alleviation shoul\d be explored.
Subject(s)
Adult , Humans , Body Surface Area , Burns , Cicatrix, Hypertrophic , Pain Management , Pruritus , Sensation , WeatherABSTRACT
Nasotracheal intubation is a useful airway management technique for head, neck, and dental surgery. However, the risks associated with this technique include the possibility of damaging the nasal mucosa and related structures including the epistaxis, pharyngolaryngeal mucosal injury, bleeding, avulsion of the turbinate, nasal polyps, sinusitis, and bacteremia. Some of these symptoms occasionally result in fatal complications. A 26-year-old male, was scheduled to undergo surgery for malocclusion type 3 under general anesthesia with nasotracheal intubation. During the nasotracheal intubation, the tip of nasotracheal tube entered into the retropharyngeal space through the nasopharyngeal wall instead of oropharyngeal space, however no blood aspiration and retropharyngeal swelling occured. After surgery, the patient was treated with broad spectrum antibiotics and conservative management, and was completely cured without further complications.