Two case reports of soft palate perforation as a complication of video laryngoscope-assisted tracheal intubation: mechanism analysis and preventative strategies

Video laryngoscopes have gradually replaced direct laryngoscopes as an aid for tracheal intubation in various scenarios, increasing intubation success rates and facilitating difficult airway management. Unlike direct laryngoscopy, video laryngoscopy carries specific risks during the intubation process. We report two cases of soft palate perforation, a rare oropharyngeal complication associated with video laryngoscopy. In the first case, video laryngoscopy was used for teaching endotracheal intubation during otolaryngology nasal bone fracture surgery, and soft palate perforation was detected via video laryngoscopy on the third intubation attempt. In the second case, video laryngoscopy was used for routine tracheal intubation in spinal surgery, and soft palate perforation was identified before extubation at the end of surgery. Current teaching curricula for video laryngoscopic tracheal intubation focus primarily on glottic visualization, yet emphasis should also be placed on the blind spot of endotracheal tube trajectory within the oral cavity under video laryngoscopy. Warnings regarding injury to oral soft tissues should be incorporated into training exercises.