Iatrogenic Foreign Body (Cotton Swab) in the Trachea after Nasotracheal Intubation

We describe our experience about a 3-inch cotton swab being misplaced in the trachea following nasotracheal intubation. A 67-year-old male patient was scheduled for oral cancer surgery. Before nasotracheal intubation, an oxymetazoline hydrochloride-soaked 3-inch cotton swab was inserted into right nostril for nasal mucosal vasoconstriction. Unpredictable difficult ventilation and intubation occurred during anesthesia induction and then fiberoptic bronchoscope-aided nasotracheal intubation was performed. The cotton swab was inconceivably found in the trachea by fiberoptic bronchoscope, and it was removed immediately by thoracic surgeon. This case demonstrates a near-miss complication during anesthesia induction. We discuss the factors which may contribute to this complication.