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Curr Ther Res Clin Exp 2019 9;90:21-26. Epub 2018 Oct 9.

Department of Anesthesia and Reanimation, Faculty of Medicine, Inonu University, Malatya, Turkey.

Objective: In this study, a north polar tube (Portex North Polar tube [Ivory PVC Portex tube; Smiths Medical International, Hythe, United Kingdom]) (NPT) and spiral tube (ST) were compared for their ability to provide a nasal airway in patients during maxillofacial surgery.

Methods: Patients who were aged 18 to 65 years with American Society of Anaesthesiologists score 1 to 2 and Mallampati score 1 to 2 were included in the study. The anesthesia technique was standardized in all patients. Read More

J Anaesthesiol Clin Pharmacol 2018 Oct-Dec;34(4):554-555

Department of Anesthesiology and Intensive Care, VMMC and Associated Safdarjung Hospital, New Delhi, India.

Am J Emerg Med 2019 Feb 11. Epub 2019 Feb 11.

Department of Emergency Medicine, Saint Vincent Hospital, Erie, PA, United States of America. Electronic address:

Background: Nasotracheal intubation is rarely performed in the emergency department (ED) but may be required in specific situations such as angioedema. Both blind and flexible nasal intubation (FNI) may be utilized; however, the preferred technique is unknown.

Methods: We performed a randomized, crossover manikin study using a convenience sample of emergency physicians and medical students from a local community teaching hospital. Read More

J Stomatol Oral Maxillofac Surg 2019 Feb 11. Epub 2019 Feb 11.

K.V.G. Dental College and Hospital, Sullia, Karnataka, India.

Background: The conventional endonasal intubation would not allow precise intra-operative assessment of the changes to the nasolabial soft tissue complex. Submental intubation allows accurate measurement of nasolabial soft tissue complex with no interference with the occlusion.

Methodology: A clinical prospective study was carried on 20 patients visiting the Oral and Maxillofacial Surgery department diagnosed of dentofacial deformity requiring orthognathic surgery. Read More

Turk J Med Sci 2019 Feb 11;49(1):116-122. Epub 2019 Feb 11.

Background/aim: Nasotracheal Airtraq is specifically designed to improve the glottis view and ease the nasotracheal intubation process in normal and difficult cases.

Materials And Methods: After Ethics committee approval, we decided to enroll 40 patients with an ASA physical status of I or II, between 18 and 70 years of age undergoing elective maxillofascial, oral, and double chin surgery to determine which nostril is more suitable for nasotracheal intubation with nasotracheal Airtraq. Patients were randomized into the right and left nostril groups. Read More

Anaesthesiol Intensive Ther 2019 Feb 6. Epub 2019 Feb 6.

Department of Paediatric Anaesthesiology and Critical Care Medicine, Asklepios Kinderklinik Sankt Augustin, German Paediatric Heart Centre, Arnold-Janssen Street 29, 53757 Sankt Augustin, Germany.

To the Editor, Nasotracheal intubation is a widely used technique in anaesthesia management for procedures including oropharyngeal, dental, and maxillofacial surgeries[1-3]. It provides an uninhibited access to the mouth and plays an important role when dealing with difficult airways[4-6]. It is also used in patients with cervical spine instability owing to injury[7] or in patients with a cervical spine fixation owing to a disease or previous operation[8]. Read More

Anesth Prog 2018 ;65(4):259-260

Department of Anesthesiology, Showa University Koto Toyosu Hospital, Tokyo, Japan.

A 23-year-old healthy man was scheduled for extraction of his mandibular third molars under general anesthesia with nasotracheal intubation. Sudden sinus tachycardia up to 170 beats/min occurred when applying an epinephrine solution-soaked swab into the nasal cavity for preventing epistaxis during intubation. This was presumably evoked by submucosal migration of the swab into a false passage created because of the force applied during a prior failed attempt at nasal passage of the tracheal tube, and rapid epinephrine absorption by the traumatized mucosa. Read More

Anesth Prog 2018 ;65(4):255-258

The Brooklyn Hospital Center, Department of Oral & Maxillofacial Surgery, Brooklyn, New York.

The purpose of this article is to describe a case of an accidental turbinectomy during nasal intubation for an elective oral and maxillofacial surgical case that was confirmed after extubation. While there are several reported cases, this still tends to be an overall rare complication in the field of anesthesia. This article highlights the complications encountered due to turbinectomy while also identifying causes, signs, and methods to prevent it. Read More

J Clin Anesth 2019 Jan 23;56:35-36. Epub 2019 Jan 23.

Department of Anaesthesiology, Tri-Service General Hospital and National Defense Medical Center, #325, Section 2, Chenggung Road, Neihu, 114 Taipei, Taiwan, Republic of China. Electronic address:

A A Pract 2019 Jan 16. Epub 2019 Jan 16.

From the Department of Anesthesiology and Perioperative Medicine, University of Rochester, Rochester, New York.

Treacher Collins syndrome is an inherited disorder resulting in maldevelopment of the first and second branchial arches. Patients have complex orofacial anatomy often requiring airway interventions from birth. A 17-year-old boy with Treacher Collins syndrome and history of difficult ventilation and intubation presented for elective maxillofacial reconstruction. Read More

BMC Anesthesiol 2019 Jan 17;19(1):14. Epub 2019 Jan 17.

Department of Neurosurgery, Qilu Hospital of Shandong University (Qingdao), Qingdao, People's Republic of China.

Background: The asleep-awake-asleep (AAA) technique and laryngeal mask airway (LMA) is a common general anesthesia technique for deep brain stimulation (DBS) surgery. However, the LMA is not always the ideal artificial airway. In this report, we presented our experiences with nasotracheal intubation-extubation-intubation (IEI) and AAA techniques in DBS surgery for Parkinson's disease (PD) patients to meet the needs of surgery and ensure patients' safety and comfort. Read More

Int J Pediatr Otorhinolaryngol 2019 Mar 15;118:120-123. Epub 2018 Dec 15.

Department of Otolaryngology, Head and Neck Surgery, University Hospital of Strasbourg, France.

Traumatic iatrogenic meningoencephaloceles infants are rare and there is no consensus on management in the literature. This article presents a case of a meningoencephalocele diagnosed 15 months after a traumatic perforation of the cribriform plate due to a difficult intubation of a preterm infant that was treated by an endoscopic endonasal surgery. A close collaboration between pediatricians and ENT surgeons appears essential for early diagnosis and management. Read More

Acta Neurochir Suppl 2019 ;125:235-240

Department of Neurosurgery, Tuscany School of Neurosurgery, University of Florence, Florence, Italy.

Background: The transoral approach provides the most direct surgical corridor for treatment of congenital bony abnormalities that exert irreducible ventral compression of the cervicomedullary junction. In this paper, based on our experience with the transoral approach over the past three decades, we briefly describe the surgical strategies and the operative nuances that allow effective decompression of the craniovertebral junction (CVJ) while minimizing postoperative morbidity.

Methods: The surgical strategy is dictated by the type and severity of the malformation. Read More

J Clin Anesth 2019 Aug 24;55:24-25. Epub 2018 Dec 24.

Instituto Maxilofacial, Centro Médico Teknon, c/Vilana, 12, Barcelona 08017, Spain. Electronic address:

J Int Med Res 2019 Jan 16;47(1):235-243. Epub 2018 Dec 16.

Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Yonsei-ro, Seodaemun-Gu, Seoul, Republic of Korea.

Objective: Nasotracheal (NT) intubation is commonly applied during head and neck surgery. However, improper tube size and depth may cause complications. In the current study, we investigated whether NT tubes are being appropriately used in terms of size and depth in adult patients. Read More

Clin Oral Investig 2019 Jan 12;23(1):493-495. Epub 2018 Dec 12.

Department of Dental Anesthesiology, Faculty of Dental Science, Kyushu University, Fukuoka, Japan.

Objectives: The selection of an appropriate size of tracheal tube is important for airway management. For nasotracheal intubation, passing the nasal cavity should be taken into account for the selection of tube size. The aim of this study was to investigate the selection of appropriate size of nasotracheal tube in pediatric patients retrospectively. Read More

Sci Rep 2018 Nov 26;8(1):17365. Epub 2018 Nov 26.

Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Republic of Korea.

We evaluated the performance of the McGrath video laryngoscope and Pentax Airway Scope in comparison with the Macintosh laryngoscope for nasotracheal intubation in paediatric patients. For this, 108 patients were enrolled in an open-label, randomized controlled trial. Patients were randomly allocated to one of three groups based on use of the Macintosh laryngoscope, McGrath video laryngoscope, or Pentax Airway Scope. Read More

J Dent Anesth Pain Med 2018 Oct 31;18(5):301-304. Epub 2018 Oct 31.

Department of Dental Anesthesiology, Faculty of Dental Science, Kyushu University, Fukuoka, Japan.

Awake fiberoptic nasotracheal intubation is a useful technique, especially in patients with airway obstruction. It must not only provide sufficient anesthesia, but also maintain spontaneous breathing. We introduce a method to achieve this using a small dose of fentanyl and midazolam in combination with topical anesthesia. Read More

J Anaesthesiol Clin Pharmacol 2018 Jul-Sep;34(3):381-385

Department of Anaesthesiology, Amrita Institute of Medical Sciences, AmritaVishwa Vidyapeetham, Kochi, Kerala, India.

Background And Aims: Nasal intubation with traditional Macintosh laryngoscope usually needs the use of Magill's forceps or external laryngeal manipulation. The primary objective of this study was to assess the ease of intubation during C-MAC videolaryngoscope-assisted nasal intubation using D blade and to compare it with traditional Macintosh laryngoscope-aided nasal intubation. The secondary objectives were comparison of intubation time, attempts, trauma, and hemodynamic stress responses. Read More

J Emerg Med 2018 Dec 10;55(6):821-826. Epub 2018 Oct 10.

Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada.

Background: Efficient airway management is paramount in emergency medicine. Our experience teaching tracheal intubation has consistently identified gaps in the understanding of important issues. Here we discuss the importance of the endotracheal tube (ETT) bevel in airway management. Read More

Paediatr Anaesth 2018 11 4;28(11):1029-1034. Epub 2018 Oct 4.

Section on Pediatric Anesthesia, Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina.

Background: Airway management in children with Pierre Robin sequence in the infantile period can be challenging and frequently requires specialized approaches.

Aims: The aim of this study was to review our experience with a multistage approach to oral and nasal intubation in young infants with Pierre Robin sequence.

Methods: After IRB approval, we reviewed 13 infants with Pierre Robin sequence who underwent a multistage approach to intubation in the operating room for mandibular distractor or gastrostomy tube placement. Read More

Anesth Analg 2018 Sep 24. Epub 2018 Sep 24.

From the Department of Anesthesiology and Pain Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea.

Background: Thermosoftening of the endotracheal tube (ETT) and telescoping the ETT into a rubber catheter have been suggested as a method for reducing epistaxis during nasotracheal intubation (NTI). However, thermosoftening technique is known to make it difficult to navigate the ETT into trachea without the use of Magill forceps during NTI. The cuff inflation technique has been suggested as an effective alternative to the use of Magill forceps to improve the oropharyngeal navigation of the ETT, irrespective of their stiffness, during direct laryngoscope-guided NTI. Read More

Int J Oral Maxillofac Surg 2019 Mar 20;48(3):291-297. Epub 2018 Sep 20.

Department of Maxillofacial and Plastic Surgery, Caen University Hospital, 14000 Caen, France.

Nasopharyngeal teratomas are rare tumours, responsible for a high birth mortality rate from acute respiratory distress. Palatine localization can lead to an embryopathogenic mechanical obstacle responsible for a cleft palate. The aim of this study was to update current knowledge concerning the management of this rare pathological association. Read More

J Dent Anesth Pain Med 2018 Aug 28;18(4):271-275. Epub 2018 Aug 28.

Department of Oral and Maxillofacial Surgery, School of Dentistry, Chonbuk National University, Jeonju, Korea.

The purpose of this study was to report and discuss the diagnosis and treatment of obstructive atelectasis secondary to pus obstruction in a patient who had developed a maxillofacial abscess, and to review the literature on similar cases. Persistently discharging pus within the oral cavity can act as an aspirate, and may lead to obstructive atelectasis. Additionally, maxillofacial surgery patients should be carefully assessed for the presence of risk factors of obstructive atelectasis, such as, epistaxis after nasotracheal intubation, oral bleeding, and mucus secretion. Read More

Anesthesiol Res Pract 2018 1;2018:4910653. Epub 2018 Aug 1.

Division of Skull Base Surgery, Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.

Background: Nasotracheal intubation is a blind procedure that may lead to complications; therefore, several tests were introduced to assess a suitable nostril for nasotracheal intubation. However, the value of simple tests in clinical practice was insufficient to evaluate.

Method: A diagnostic prospective study was conducted in 42 patients, ASA classes I-III, undergoing surgery requiring nasotracheal intubation for general anesthesia. Read More

J Clin Anesth 2019 Feb 25;52:6-16. Epub 2018 Aug 25.

Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China. Electronic address:

Study Objective: Nasotracheal intubation (NTI) is a common practice in the oral and maxillofacial surgeries. A systematic review and meta-analysis was performed to determine whether videolaryngoscopy (VL) compared with direct laryngoscopy (DL) can lead to better outcomes for NTI in adult surgical patients.

Measurements: Only randomised controlled trials comparing VL and DL for NTI were included. Read More

Turk J Anaesthesiol Reanim 2018 Aug 1;46(4):333-334. Epub 2018 Aug 1.

Department of Anaesthesiology and Intensive care, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India.

J Craniofac Surg 2018 Oct;29(7):1952-1955

Department of Plastic Surgery, Kyorin University School of Medicine, Shinkawa, Mitaka, Tokyo, Japan.

In 1986, Altemir first reported the use of submental intubation to avoid tracheotomy in patients with panfacial and midfacial fractures for whom intermaxillary fixation is necessary, but orotracheal and nasotracheal intubations are not recommended. This novel technique allowed intraoperative access to perform dental occlusion and reconstruction of the nasal pyramid in patients with skull base fractures. Herein, we describe a refined technique based on Altemir's original procedure. Read More

J Anaesthesiol Clin Pharmacol 2018 Apr-Jun;34(2):258-259

Department of Anaesthesia, AIIMS, Patna, Bihar, India.

Anesth Analg 2018 Dec;127(6):1421-1426

From the Department of Anesthesiology and Pain Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea.

Background: For safe nasotracheal intubation without middle turbinate injury, the tracheal tube should pass through the lower pathway, which is beneath the inferior turbinate and immediately above the nasal floor of the nostril. The purpose of this study was to assess the influence of nasal tip lifting on the incidence of passing preformed nasal Ring-Adair-Elwyn (RAE) tubes through the lower pathway during nasotracheal intubation.

Methods: Patients were randomly assigned to a "nasal tip lifting group" or a "neutral group. Read More

Ugeskr Laeger 2018 Jul;180(27)

Ipsilateral extracranial palsy of the hypoglossus and vagus nerve is a rare complication of intubation. This is a case report of a 50-year-old male with unilateral palsy of the hypoglossus and vagus nerve after reoperation for a mandibular fracture. The patient underwent logopaedic treatment, and ten months after the operation there was significant but not complete remission of symptoms. Read More

J Dent Anesth Pain Med 2018 Jun 29;18(3):183-187. Epub 2018 Jun 29.

Anaesthesiology, Saveetha University, Chennai, India.

Complex cervical spine fractures are a serious complications of maxillofacial trauma and associated with high mortality and neurological morbidity. Strict vigilance in preventing further insult to the cervical spine is a crucial step in managing patients who are at risk for neurologic compromise. We report a rare case of a right transverse process of atlas fracture with right-sided vertebral artery injury that was associated with a comminuted fracture of the body and angle of the mandible, which restricted mouth opening. Read More

Acta Anaesthesiol Scand 2018 Nov 3;62(10):1383-1388. Epub 2018 Jul 3.

Department of Dental Anesthesiology, Faculty of Dental Science, Kyushu University, Fukuoka, Japan.

Background: A tracheal tube is often inserted via the nasal cavity for dental surgery. The position of the tube tip is important, given that the head position sometimes changes during surgery. Head movement induces changes in the length of the trachea (t-length) and/or the distance between the nare and the vocal cords (n-v-distance). Read More

Anesth Essays Res 2018 Apr-Jun;12(2):581-585

Department of Anaesthesiology and Critical Care, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth (Deemed-to be- University), Puducherry, India.

Background: Several video laryngoscopes had demonstrated their superiority over conventional oral and nasal intubation techniques. King Vision video laryngoscope has fewer studies supporting its suitability for oral intubations. However, its suitability as a nasal intubating device has not been yet evaluated. Read More

Anesth Prog 2018 ;65(2):100-105

Product Development Research Center, Daiken Medical Co Ltd, Osaka, Japan.

Thermosoftening treatment of polyvinyl chloride (PVC) nasotracheal tubes (NTTs) can reduce the incidence and amount of epistaxis during nasotracheal intubation. The optimal thermal setting for thermosoftening treatment of NTTs without burn injury was investigated. Two composite types of PVC NTTs were used. Read More

Anesth Prog 2018 ;65(2):89-93

Assistant Professor and Director General Practice Residency, Department of Surgery, Division of Dentistry, University of Toledo Medical Center, Toledo, Ohio.

The purpose of this article was to determine if pediatric dental treatment under general anesthesia utilizing orotracheal intubation takes longer than using nasotracheal intubation techniques. Twenty-six American Society of Anesthesiologists Physical Status Classification I and II pediatric dental patients, ages 2-8 years treated under general anesthesia, were assigned to 1 of 2 groups: (a) nasotracheal intubation (control, n = 13), (b) orotracheal intubation (experimental, n = 13). Times for intubation, radiographic imaging, and dental procedures, as well as total case time were quantified. Read More

A A Pract 2018 May;10(10):254-257

Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.

Managing the airway of an infant with Pierre Robin sequence (PRS) is particularly challenging for anesthesiologists. Patients with PRS have the triad of micrognathia, glossoptosis, and airway obstruction that potentially and frequently leads to difficulty with both ventilation and intubation. Thus continuous oxygenation and spontaneous ventilation during intubation are essential. Read More

J Dent Anesth Pain Med 2018 Apr 27;18(2):125-128. Epub 2018 Apr 27.

Department of Dental Anesthesiology, Seoul National University Dental Hospital, Seoul, Republic of Korea.

In cases of a difficult intubation where numerous intubation methods, including laryngoscopy, have failed, yet oral intubation is still necessary, the method of tube exchange after fiberoptic nasal intubation may be attempted. Fiberoptic nasal intubation allows intubation to be performed relatively easily when the laryngeal view grade is poor. We report a case in which our attempt at oral intubation for total maxillectomy with laryngoscopy and fiberoptic oral intubation had failed due to an unexpected difficult airway; subsequently, we successfully completed the surgery by performing fiberoptic nasal intubation to secure the airway, followed by using a tube exchanger to exchange to an oral endotracheal tube. Read More

Turk J Anaesthesiol Reanim 2018 Apr 27;46(2):96-99. Epub 2017 Nov 27.

Department of Anaesthesiology and Critical Care, Indra Gandhi Government Medical College and Research Centre, Puducherry, India.

Objective: Bleeding due to inadvertent trauma is a troublesome complication of nasal intubations. A lot of methods have been suggested to minimise this problem. A flexible bougie can be passed atraumatically via the nasal route to the trachea and an appropriate-sized endotracheal tube can be railroaded over it to avoid this problem. Read More

J Oral Maxillofac Surg 2018 Oct 11;76(10):2231-2240. Epub 2018 Apr 11.

Director and Associate Professor, Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, McGill University, Montreal, Quebec, Canada; and Chief, Department of Dentistry and Oral and Maxillofacial Surgery, McGill University Health Centre, Montreal, Quebec, Canada. Electronic address:

Purpose: We aimed to describe the safety and effectiveness of nasotracheal intubation (NTI) in a cohort of patients undergoing reconstruction of oral cavity defects with free tissue transfer (FTT).

Materials And Methods: We implemented a retrospective cohort study and enrolled a sample composed of consecutive patients undergoing FTT reconstruction of oral cavity, maxillary, or mandibular defects between 2013 and 2017. These patients were all subject to a newly developed enhanced recovery-after-surgery protocol. Read More

JAMA 2018 05;319(17):1790-1801

Neonatal Intensive Care Unit, CHI Créteil, CRETEIL, France.

Importance: Propofol or a combination of a synthetic opioid and muscle relaxant are both recommended for premedication before neonatal intubation but have yet to be compared.

Objective: To compare prolonged desaturation during neonatal nasotracheal intubation after premedication with atropine-propofol vs atropine-atracurium-sufentanil treatment.

Design, Setting, And Participants: Multicenter, double-blind, randomized clinical trial (2012-2016) in 6 NICUs in France that included 173 neonates requiring nonemergency intubation. Read More

A A Pract 2018 Oct;11(7):184-185

From the Department of Anesthesiology, Kawasaki Municipal Hospital, Kawasaki, Japan.

Knotting of a nasogastric (NG) tube around a left nasotracheal tube occurred in the pharynx during its blind insertion via the right nares. Unusual resistance was encountered during its advancement and attempted withdrawal. The nasotracheal tube moved in tandem with the NG tube. Read More

Anesth Analg 2018 Aug;127(2):485-489

From the Department of Anesthesia and Critical Care, University of Chicago Medical Center, Chicago, Illinois.

Background: Epistaxis, or nasal bleeding, is a common complication after nasotracheal intubation (NTI). Because such bleeding is likely related to trauma during intubation, use of fiberoptic visualization and guidance rather than direct laryngoscopy may affect the incidence and severity of epistaxis. We compared the incidence of epistaxis after NTI using a fiberoptic versus a direct laryngoscopy approach. Read More

Anesth Essays Res 2018 Jan-Mar;12(1):282-284

Department of Anaesthesia and Critical Care, Armed Forces Medical College, Pune, India.

Intubating a pediatric patient with temporomandibular joint ankylosis is a daunting task, and it becomes more challenging with limited mouth opening. Fiberoptic nasotracheal intubation technique is considered a gold standard. We describe an improvised technique of securing airway in the absence of appropriate-sized fiberoptic scope. Read More

Korean J Anesthesiol 2018 Apr 2;71(2):120-126. Epub 2018 Apr 2.

Department of Anesthesia, Jawaharlal Nehru Medical College, Ajmer, India.

Background: The preferred management strategy for difficult airways is awake fiberoptic bronchoscopy-guided intubation, which requires effective airway anesthesia to ensure patient comfort and acceptance. This randomized single-blind prospective study was conducted to compare lignocaine nebulization and airway nerve block for airway anesthesia prior to awake fiberoptic bronchoscopy-guided intubation.

Methods: Sixty adult patients scheduled for surgical procedures under general anesthesia were randomly allocated to two groups. Read More

Otolaryngol Head Neck Surg 2018 Sep 3;159(3):439-441. Epub 2018 Apr 3.

2 Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA.

To describe the relationship between jaw opening and access to the deep parotid window, we identified the following distances in 10 human skulls: symphysis to angle of mandible, mastoid tip to angle of mandible, angle of mandible to condylar process, and mastoid tip to condylar process. With the jaw closed and open, these distances were measured with 1 to 3 wooden blocks, each measuring 1 cm, between the upper and lower incisors. The triangular deep parotid area formed by the last 3 distances was calculated. Read More