Head and neck surgical patients; is it time for a bridle era?

Early enteral feeding is vital for successful outcomes in patients who have undergone open pharyngeal surgery, with nasogastric tube (NGT) feeding being a safe and accepted method of providing enteral nutrition in the short-term. Securing the NGT is key to ensure adequate caloric consumption and avoid the potential complications of re-siting the tube. The aim of this study was to compare the efficacy of utilising an anterior septal suture to a bridle system for NGT fixation. A sheep's head model was used to represent the nasal cavity of post-operative patients and a fine-bore NGT was passed. The NGT was secured with either an anterior septal suture or bridle system. A pulley system of weights was applied until the NGT slipped or snapped. Each weight and condition was investigated five times. The anterior and posterior septum were examined for evidence of damage for each condition. At 5 kg the anterior septal suture allowed the NGT to slip and the tube began to become distorted. At 5.5 kg the anterior septal suture snapped the NGT. In comparison, the bridle system was able to sustain a weight up to 15.5 kg (Fisher's exact test, p = 0.0079). There was no evidence of damage to the anterior or posterior septum for each condition. The bridle system was able to fix the NGT without slippage or damage at higher weights than the anterior septal suture. This suggests there may be potential benefits of stronger NGT fixation with reduced tube damage using bridle systems in patients, but further research is required in this domain.