Nasotracheal intubation for airway management during anesthesia

Abstract

Nasotracheal intubation is used as a basic method for airway management, along with orotracheal intubation under anesthesia and intensive care. It has become an effective alternative method to orotracheal intubation with increased benefits of offering better mobility and surgical field in oral and maxillofacial surgery and possibly in trauma and critically ill patients. Nasotracheal intubation is performed through a relatively narrow nasal cavity; therefore, additional precautions are needed. Accordingly, nasotracheal intubation methods have evolved over the years with accumulated clinical experience and improved instruments to facilitate safe intubation with reduced complications. Therefore, in this review article, we summarize the basic anatomy of the nasal airways to clarify the precautions, delineate the history and development of various methods and instruments, and describe the indications, contraindications, complications, and preventive methods of nasotracheal intubation.

Submental Intubation in Maxillofacial Procedures: A More Desired Approach Than Nasotracheal Intubation and Tracheostomy

“…Performing the procedure in these patients will lead to severe adverse outcomes especially if the tube was inserted blindly. While Fiberoptic bronchoscopy-guided intubation or a video laryngoscopy with the right forceps can be used to guide the endotracheal tube appropriately and may contribute to reducing morbidity, the absolute contraindications mention in Table 1 should be considered and nasotracheal intubation is to be avoided [10][11][12][13]. Consequences may involve intracranial penetration of the tube which may result in cerebrospinal spinal fluid leakage as well as infection of the epidural space.…”

“…Air embolism can be added to the list of general and early complications of the procedure [16,17]. While complications such as tracheal stenosis, tube blockage, respiratory infection, development of a tracheoesophageal fistula, voice changes, tracheal granuloma, unfavorable scar tissue formation, and deformity may present in the later periods following the procedure [9][10][11][18][19][20][21][22]. Reportedly early complications of tracheostomy had an incidence of 6%-8% while the incidence of late complications was 60% [10].…”

“…According to Park et al, nasotracheal intubation is normally indicated in patients who are undergoing maxillofacial, intranasal, oropharyngeal, mandibular surgery, dental procedures, and surgeries involving the cervical spine where there may be cervical spine degenerative diseases and instability. Other indications and contraindications of nasotracheal intubations explored in some of the cases and articles reviewed are tabulated in Table 1 [ 11 ].…”

“…Considerations should be done in patients who require prolonged intubation as well. These patients are prone to developing nasal pressure sores and deformed nasal anatomy [ 10 , 11 ].…”

“…Submental intubation provided unobstructed access to the surgical field and allowed both Surgeons and Anesthesiologists to perform their roles with minimal concerns for the interference of the endotracheal tube [ 8 ]. The increased postoperative care seen with a tracheostomy was not experienced when submental intubation was utilized, and the patients had a shortened hospital stay [ 9 , 11 , 13 , 15 ]. In one study, the tube was kept in place for 1 to 4 days and it was well tolerated.…”