A Safer Technique for Nasal Intubation: A Literature Review

Abstract

Nasotracheal intubation (NTI) is the most widely used method to establish an airway during anesthesia for oral surgery. It has the advantage of providing exceptional accessibility and optimal working conditions in the oral cavity for surgeons. Anesthesia providers are highly trained in managing and securing the airway. Because the oral intubation route is the most widely used technique for securing the airway, nasal intubation can be cumbersome for anesthetists who do not routinely perform this skill. Moreover, anesthesia providers who do not routinely perform NTI may feel apprehension out of concern for nasopharyngeal bleeding and trauma. The number of dental and oromaxillofacial procedures requiring nasal intubation has been steadily growing annually. Although NTI is generally safe, it still presents a risk for complications. The purpose of this literature review was to examine current literature and evidence-based practices of NTI to determine whether the use of a catheter-guided technique will improve patient care outcomes by way of decreased trauma to the airway compared to current clinical practices. The goal of this review is to recommend the use of a catheter-guided technique for NTI as the preferred method for securing the airway during oral surgery as it is less traumatizing to the airway than conventional methods.

Temporomandibular Joint Ankylosis: Anesthetic Challenge

“…With limited mouth opening, the potential options are retrograde intubation, tracheostomy, and nasal intubation with either blind or fiberoptic assistance. Despite being largely safe, nasotracheal intubations (NTIs) nevertheless carry the risk of significant side effects, including trauma and nasopharyngeal hemorrhage [ 6 ].…”

The use of CBCT prior to Nasal Intubation for Orofacial Surgical Procedure

“…In orthognathic surgery, nasotracheal intubation is the preferred method of securing the airway as it maintains exceptional access to the surgical eld and allows veri cation of interocclusal relationships between the maxilla and mandible [1]. Common risks of nasal intubation include nasal mucosal trauma and epistaxis, while the less common but irreversible complications include turbinate and olfactory nerve damage.…”