Identifying the more suitable nostril for nasotracheal intubation using radiographs

Abstract

BackgroundOne nostril must be selected for nasotracheal intubation. In some cases, structural anomalies within the nasal cavity hinder the insertion of the tube or complications, such as epistaxis, develop. This study examined the possibility of using radiography to select the nostril that would induce fewer complications.MethodsFour hundred and five patients who underwent nasotracheal intubation under general anesthesia were studied. A 7.0-mm internal diameter nasal right angle endotracheal (RAE) tube and 6.5-mm internal diameter nasal RAE tube were inserted into men and women, respectively. Complications were considered to have developed in cases in which insertion of the tube into the nasal cavity failed or epistaxis occurred. The tube was inserted into the other nostril for insertion failures and hemostasis was performed in cases of epistaxis. The degree of nasal septal deviation was determined from posteroanterior skull radiographs or panoramic radiographs; the incidence of complications was compared depending on the direction of the septal deviation and the intubated nostril.ResultsThe radiographs of 390 patients were readable; 94 had nasal septum deviation. The incidence of complications for cases without nasal septum deviation was 16.9%, that for cases in which the tube was inserted into the nostril on the opposite side of the deviation was 18.5%, and that for cases in which the tube was inserted into the nostril with the deviation was 35.0%, showing a high incidence of complications when intubation is performed through the nostril with septum deviation (chi-square test, P < 0.05 ).ConclusionsAlthough there were no differences in the incidence rates of complications between intubation through the left nostril and that through the right nostril, radiological findings indicated that incidence of complications significantly increased when the tube was inserted into the nostril with the septum deviation.

Risk factors affecting the difficulty of fiberoptic nasotracheal intubation

“…There are many known ways to reduce epistaxis during nasotracheal intubation. Dipping a tracheal tube into a warm saline for thermosoftening [21][22][23], lubricating with xylocaine jelly [24], using a vasoconstrictor [25], using a tracheal tube with a smaller internal diameter than oral intubation [1], using radiographs to select more appropriate nostril [26], and if there is no difference between both nostrils, intubation with right nostrils is a typical way to reduce bleeding [27]. Tube passing underneath the inferior turbinate has also been recently suggested as a way to reduce epistaxis [28].…”

North Polar Tube Reduces the Risk of Epistaxis during Nasotracheal Intubation: A prospective, Randomized Clinical Trial

“…Some studies have claimed that the choice of the left nostril by orthognathic surgeons is more beneficial 28 . Chi et al 29 showed no significant relationship between the choice of the right or left nasal passage and incidence of complications in NTI. Some studies have suggested that the selection of the left nostril during NTI increases the complication rates 30 .…”

Nasotracheal intubation for airway management during anesthesia

“…Flexible endoscopy also allows for detailed examination of the entire nasal cavity for nostril selection [2][3][4]. Depending on the patient's condition, methods such as facial radiography, CT, and MRI can be used to examine anatomical and pathological abnormalities such as SD [23,24].…”