Severe nasal frostbite injury from supplemental nasal cannula oxygen malfunction

Educational Objectives: (1) describe a potential complication of nasal cannula supplemental oxygen administration not previously reported in the literature (2) describe management techniques (3) describe the physical properties of compressed oxygen release. Study Design: Case report and descriptive study Methods: Medical records from a patient who sustained severe frostbite injury from malfunction of supplemental nasal cannula oxygen were reviewed. Studies of compressed air released at various pressures were performed. Results: Severe injury to the anterior nasal cavity, nasal ala, columella and nasal dorsum with associated significant bilateral periorbital and nasolabial edema were sustained. Necrotic tissue was debrided operatively under local anesthesia with monitored anesthesia care. Serial dressing changes with silver sulfadiazine and silastic stenting of the nasal passage were utilized in the postoperative period. Temperature variation as a function of pressure is reported. Conclusions: Malfunction of supplemental oxygen at high volumes may be associated with a severe frostbite type injury. These lesions may be managed similarly to classic thermal injuries with debridement and wound cares.