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Palatal groove formation and oral endotracheal intubation.

Sir .—In a recent article, Erenberg and Nowak 1 proposed a hypothesis for groove formation secondary to oral endotracheal intubation: "... continuous pressure of the endotracheal tube against the median palatine suture." An alternative explanation would be the absence (or presence) of tongue pressure against the palatal shelves, which allows the shelves to grow toward each other. This would explain grooving in the midline when the endotracheal tube is secured away from the midline, ie, at either corner of the mouth. In our unit, oral endotracheal tubes are secured at the mouth corners and, hence, the endotracheal tubes do not traverse the midline. Still, we invariably see midline grooving in patients treated with prolonged oral endotracheal intubation. In our experience, these grooves eventually resolve after extubation, although this may take some time. The tongue is known to play an important role in palate-shape development. 2,3 Absence from its proper position leads to