Oral complications associated with neonatal oral tracheal intubation: a critical review.

This paper summarizes and evaluates the oral complications associated with orotracheal intubation in neonates. The palatal defect resulting from orotracheal intubation is best described as palatal grooving, rather than clefting since no oral nasal communication has been demonstrated. Palatal grooving may be caused by the inhibition of the molding tongue forces on the lateral palatine shelves. The incidence of palatal grooving increases with duration of intubation and reportedly resolves following extubation. However, posterior cross-bites, high palatal vaults, and poor speech intelligibility have been reported in children who previously have been intubated. Impingement of an orotracheal tube on the alveolus rather than on the palate may cause alveolar grooving which can cause dilaceration of primary teeth. Bilateral linear enamel hypoplasia in premature neonates is caused by an interruption in amelogenesis from intrauterine disturbances. However, gross unilateral incisal enamel hypoplasia in children who have been intubated is probably due to traumatic intubation. Avoiding excessive pressure on the maxillary alveolus during intubation is suggested. An appliance is available which secures oral tubes and protects the palate and alveolus.