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BMC Anesthesiol 2020 May 14;20(1):114. Epub 2020 May 14.

Department of anesthesiology and pain medicine, Hallym University Sacred Heart Hospital, Hallym University School of Medicine, 22, Gwanpyeong-ro 170 beon-gil, Dong-gu, Anyang-si, Gyeonggi-do, 14068, Republic of Korea.

Background: Immobilization with cervical spine worsens endotracheal intubation condition. Though various intubation devices have been demonstrated to perform well in oral endotracheal intubation, limited information is available concerning nasotracheal intubation (NTI) in patients with cervical spine immobilization. The present study compared the performance of the C-MAC D-Blade videolaryngoscope with the McCoy laryngoscope for NTI in patients with simulated cervical spine injuries. Read More

J Maxillofac Oral Surg 2020 Jun 24;19(2):324-326. Epub 2020 Jan 24.

2Maxillofacial Surgery, Post Graduate Institute of Dental Sciences, University of Heath Sciences, Rohtak, India.

Background: Maxillofacial surgeries are known to have difficulty in airway management due to anatomical and functional reasons. Tumors of maxillofacial region and diseases of TM joint limit mouth opening as well as airway space. Various methods have been tried with success for nasotracheal intubation including fiberoptic-aided as well as blind nasal and light-guided intubation. Read More

IDCases 2020 9;19:e00669. Epub 2019 Nov 9.

Unidade de Cuidados Intensivos Polivalentes, Centro Hospitalar Universitário do Porto, Portugal.

Introduction: Deep neck space infections most commonly arise from a septic focus of the mandibular teeth, tonsils, parotid gland, middle ear or sinuses, usually with a rapid onset and frequently with progression to life-threatening complications. Lemierre's syndrome is classically defined by an oropharyngeal infection with internal jugular vein thrombosis followed by metastatic infections in other organs.

Case Presentation: A 32-year-old female patient, with no significant past medical history, was diagnosed with a dental abscess on her left inferior 3 molar. Read More

Pediatr Crit Care Med 2020 Mar 12. Epub 2020 Mar 12.

All authors: Division of Pediatric Critical Care, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI.

Objectives: The use and outcomes of nasotracheal intubation in pediatric patients requiring mechanical ventilation have not been quantified. Our goal is to identify prevalence of use, associated factors, and outcomes of nasotracheal versus orotracheal intubation in patients requiring mechanical ventilation.

Design: Retrospective cohort study using deidentified data from the Virtual Pediatric Systems database. Read More

Turk J Med Sci 2020 Mar 28. Epub 2020 Mar 28.

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Turk J Med Sci 2020 Mar 17. Epub 2020 Mar 17.

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Turk J Med Sci 2020 Mar 10. Epub 2020 Mar 10.

I have written my reflections on an article published in the Feb 2019 issue of T.J.M. Read More

J Clin Med 2020 Mar 2;9(3). Epub 2020 Mar 2.

Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.

The optimal head position for GlideScope facilitated nasotracheal intubation has not yet been determined. We compared the neutral and sniffing positions to establish the degree of intubation difficulty. A total of 88 ASA I-II patients requiring nasotracheal intubation for elective dental surgery with normal airways were divided into two groups according to head position, neutral position (group N), and sniffing position (group S). Read More

Clin Cosmet Investig Dent 2020 19;12:41-48. Epub 2020 Feb 19.

Department of Orthodontics and Dentofacial Orthopaedics, UCMS College of Dental Surgery, Bhairahawa, Rupandehi, Nepal.

Introduction: Airway management in patients with panfacial fracture remains a challenge to anesthesiologists and surgeons. Submental intubation is an effective and less invasive alternative to tracheostomy during intraoperative airway management where orotracheal and nasotracheal intubation are not appropriate options. In addition, submental intubation allows proper access to oronasal airways and occlusion during intraoperative management. Read More

Harefuah 2020 Feb;159(1):113-116

Otolaryngology Head.

Introduction: Tracheal intubation is a vital and common procedure during surgical care. The tracheal tube may be inserted orally or trans-nasally. Nasal intubation enables a non-restricted approach for oral and oropharyngeal regions. Read More

J Dent Anesth Pain Med 2019 Dec 27;19(6):389-392. Epub 2019 Dec 27.

Department of Anesthesiology and Pain Medicine, Dankook University Hospital, Cheonan, Korea.

An enlarged inferior turbinate is a predisposing factor for difficult nasotracheal intubation. We describe a case of successful nasotracheal intubation by induced outfracture of the inferior turbinate during maxillofacial surgery, and discuss the importance of adequate airway evaluation and anesthetic management for successful nasal intubation. Read More

J Craniofac Surg 2020 May/Jun;31(3):e306-e309

Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Pernambuco, Recife.

Psammomatoid juvenile ossifying fibroma (PJOF) is a rare benign tumor that usually affects the paranasal sinuses, orbit, and skull. In most cases, extensive incisions are necessary for full access to the tumor site. The aim of this paper is to report a case of extensive PJOF in which an intraoral surgical approach was performed with complete excision of the tumor. Read More

J Craniofac Surg 2020 Mar/Apr;31(2):562-563

Oral and Maxillofacial Surgery Residency Program, Hospital João XXIII/FHEMIG.

The submental intubation is a well-described technique as an alternative for the tracheostomy in the airway management in patients with contraindications for the nasotracheal and cannot remain in the orotracheal position due to the need to maintain the intermaxillary fixation. Residents and young oral and maxillofacial surgeons could have experienced some difficulty performing the technique first described by Altemir (1986). This report aims to describe a new device designed to facilitate and simplify the technique helping surgeons on the submental endotracheal intubation. Read More

Heliyon 2020 Jan 31;6(1):e03069. Epub 2019 Dec 31.

Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand.

Purpose: To prospectively investigate the risk factors that associate to ala nasi pressure sores after general anesthesia with nasotracheal intubation.

Material And Method: All Patients underwent oral and maxillofacial surgeries during May 2018 to December 2018 were enrolled in this prospective study. Alae nasi were evaluated after finishing of the operation under general anesthesia with nasotracheal intubation for having pressure sore or not. Read More

Anesth Prog 2019 ;66(4):211-217

Department of Dental Anesthesiology and Pain Management, Tohoku University Hospital, Sendai, Japan.

Epistaxis is one of the most common complications of nasotracheal intubation and can be life-threatening. However, there is little discussion in the current literature on the acute management of massive epistaxis after nasotracheal extubation. This is a report of 2 patients who experienced severe unanticipated nasal bleeding immediately after extubation, 1 after a surgical procedure for oral cancer and another after restorative dental treatment. Read More

A A Pract 2020 Feb;14(3):75-78

From the Department of Anesthesiology, Tokyo Dental College, Ichikawa General Hospital, Ichikawa, Japan.

Fibrodysplasia ossificans progressiva (FOP) is a rare hereditary disorder causing neck stiffness, ankylosis of temporomandibular joints, and severe restrictive respiratory dysfunction due to progressive heterotopic ossification of the connective tissue. Herein, we report a case of successful airway and anesthesia management using a high-flow nasal cannula (HFNC) in a 51-year-old man with FOP undergoing partial bone resection of the right greater trochanter of the femur. Although general anesthesia with awake fiberoptic nasotracheal intubation has been described as the gold standard, HFNC may yield another potentially viable option for patients undergoing a surgical procedure that does not involve the airway. Read More

Natl J Maxillofac Surg 2019 Jul-Dec;10(2):212-216. Epub 2019 Nov 12.

Department of Anaesthesiology, KGMU, Lucknow, Uttar Pradesh, India.

Background And Aims: Flexible fiber-optic intubation is considered to be the gold standard for management of difficult airway. Fiber-optic intubation does require effective sedation and blunting of airway reflexes for which various drug regimens have been utilized in the past. In a quest to find the noble drug combination, we combined ketamine and dexmedetomidine in two different doses, to evaluate the clinical efficacy and safety profile of ketamine and dexmedetomidine for fiber-optic intubation. Read More

J Crit Care 2020 Apr 14;56:12-17. Epub 2019 Nov 14.

Department of Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, State Key Lab of Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China. Electronic address:

Purpose: This study investigated the feasibility and efficacy of continuous noninvasive ventilation (NIV) support with 100% oxygen using a specially designed face mask, for reducing desaturation during fiberoptic bronchoscopy (FOB)-guided intubation in critically ill patients with respiratory failure.

Materials And Methods: This was a single-center prospective randomized study. All patients undergoing FOB-guided nasal tracheal intubation were randomized to bag-valve-mask ventilation or NIV for preoxygenation followed by intubation. Read More

Spine (Phila Pa 1976) 2020 May;45(9):565-572

Department of Anesthesiology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan.

MINI: This randomized clinical trial showed different intubation mode in anesthesia did not affect the increase of endotracheal cuff pressure caused by the retractor splay in anterior cervical spine surgery. However, nasotracheal intubation improved postoperative dysphonia recovery after anterior cervical spine surgery.

Study Design: Prospective, randomized, double-blinded trial. Read More

Med J Armed Forces India 2019 Oct 5;75(4):476-478. Epub 2018 Apr 5.

Assistant Professor (Physiology), Kamineni Institute of Medical Sciences, Narketpally, Telangana 508254, India.

Nasotracheal intubation could be associated with a variety of complications, of which traumatic complications are commonly encountered. We present a rare case of retropharyngeal submucosal false passage which occurred during nasotracheal intubation inspite of avoiding potential risk factors known for causing nasopharyngeal trauma. Risk factors, preventive measures and probable reason for this complication have been discussed. Read More

Br J Oral Maxillofac Surg 2020 01 11;58(1):43-50. Epub 2019 Nov 11.

Discipline of Oral & Maxillofacial Surgery, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074. Electronic address:

Submental intubation is a low-risk alternative to tracheostomy when nasotracheal or orotracheal intubation is not appropriate. To improve the selection of patients and clinical outcomes we have explored published papers on submental intubation in oral and maxillofacial surgery, and included a proposal for a decision pathway. Systematic searches of PubMed, Scopus, and Cochrane databases for papers published between 1986 and 2018 yielded 116 eligible articles (one randomised controlled trial, 61 case series, 40 case reports, six surgical techniques, and eight letters) that included 2 229 patients. Read More

Anaesth Intensive Care 2019 Sep;47(3_suppl):6-16

Royal Children's Hospital, Melbourne, Australia.

Dr Ian Hamilton McDonald (1923-2019) was a pioneer of paediatric anaesthesia and intensive care at the Royal Children's Hospital, Melbourne. He first started working at the hospital in the 1940s, later doing further training from 1953-1955 at the Nuffield Department of Anaesthesia in Oxford under Sir Robert Macintosh. McDonald returned to Melbourne as assistant director supporting Dr Margaret (Gretta) McClelland as the director of anaesthesia, together pioneering the development of a major paediatric anaesthesia department. Read More

Turk J Med Sci 2020 02 13;50(1):279. Epub 2020 Feb 13.

Department of Anesthesiology and Reanimation, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey

Turk J Med Sci 2020 02 13;50(1):277-278. Epub 2020 Feb 13.

Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, P.R. China

No abstract. Read More

Medicine (Baltimore) 2019 Oct;98(42):e17713

Division of Pulmonary, Allergy, and Critical Care Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, Republic of Korea.

Few data are available regarding factors that impact cricothyrotomy use and outcome in general hospital setting. The aim of the present study was to determine the incidence and outcomes of the patients underwent cricothyrotomy in a "cannot intubate, cannot oxygenate" (CICO) situation at university hospitals in Korea.This was a retrospective review of the electronic medical records of consecutive patients who underwent cricothyrotomy during a CICO situation between March, 2007, and October, 2018, at 2 university hospitals in Korea. Read More

Medicine (Baltimore) 2019 Oct;98(40):e17473

Department of Anesthesiology and Intensive Care Medicine.

Awake craniotomy is a unique technique utilized for mapping neuro and motor function during neurosurgical procedures close to eloquent brain tissue. Since active communication is required only during surgical manipulation of eloquent brain tissue and the patient is "sedated" during other parts of the procedure, different methods for anesthesia management have been explored. Furthermore, airway management ranges from spontaneous breathing to oro or nasotracheal intubation. Read More

Ther Clin Risk Manag 2019 18;15:1121-1128. Epub 2019 Sep 18.

Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon 16499, South Korea.

Purpose: Videolaryngoscopy in nasotracheal intubation has been reported to be better than direct laryngoscopy. The most suitable type of videolaryngoscope remains unknown. This study aimed to compare two videolaryngoscopes (McGrath MAC and Pentax AWS) with a Macintosh laryngoscope during nasotracheal intubation. Read More

Br J Oral Maxillofac Surg 2019 12 31;57(10):1167-1168. Epub 2019 Aug 31.

Anesthesiology, Suleyman Demirel University School of Medicine, 32200 Isparta, Turkey. Electronic address:

Br J Oral Maxillofac Surg 2019 11 28;57(9):950-952. Epub 2019 Aug 28.

Southampton General Hospital. Electronic address:

BMC Anesthesiol 2019 08 31;19(1):166. Epub 2019 Aug 31.

Department of Anesthesiology, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China.

Background: King Vision and McGrath MAC video laryngoscopes (VLs) are increasingly used. The purpose of this study was to evaluate the performance of nasotracheal intubation in patients with predicted difficult intubations using non-channeled King Vision VL, McGrath MAC VL or Macintosh laryngoscope by experienced intubators.

Methods: Ninety nine ASA I or II adult patients, scheduled for oral maxillofacial surgeries with El-Ganzouri risk index 1-7 were enrolled. Read More

BMC Anesthesiol 2019 08 31;19(1):168. Epub 2019 Aug 31.

Department of Anesthesiology and Intensive Care Medicine, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan.

Background: Nasotracheal intubation can potentially result in microbial contamination from the upper respiratory tract to the lower respiratory tracts. However, an ideal nasotracheal disinfection method is yet to be determined. Therefore, we compared the disinfection effects between benzalkonium chloride and povidone iodine in nasotracheal intubation. Read More

BMC Anesthesiol 2019 08 23;19(1):163. Epub 2019 Aug 23.

Hefei National Laboratory for Physical Sciences at the Microscale, Department of Biophysics and Neurobiology, University of Science and Technology of China, Hefei, 230027, People's Republic of China.

Background: Nasotracheal intubation (NTI) is frequently performed for oral and maxillofacial surgeries. This study evaluated whether NTI is easier when guided by Disposcope endoscopy or fibreoptic bronchoscopy.

Methods: Sixty patients (30 per group) requiring NTI were randomly assigned to undergo fibreoptic bronchoscopy-guided (fibreoptic group) or Disposcope endoscope-guided (Disposcope group) NTI. Read More

Anesth Analg 2019 09;129(3):812-818

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

BMC Anesthesiol 2019 08 17;19(1):158. Epub 2019 Aug 17.

Department of Anesthesiology and Pain Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea.

Background: Clinicians sometimes encounter resistance in advancing a tracheal tube, which is inserted via a nostril, from the nasal cavity into the oropharynx during nasotracheal intubation. The purpose of this study was to investigate the effect of neck extension on the advancement of tracheal tubes from the nasal cavity into the oropharynx during nasotracheal intubation.

Methods: Patients were randomized to the 'neck extension group (E group)' or 'neutral position group (N group)' for this randomized controlled trial. Read More

Can J Anaesth 2020 Feb 13;67(2):268-269. Epub 2019 Aug 13.

Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China.

Can J Anaesth 2020 Feb 13;67(2):270-271. Epub 2019 Aug 13.

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

Zhongguo Yi Xue Ke Xue Yuan Xue Bao 2019 Jun;41(3):379-382

Department of Anesthesiology,Plastic Surgery Hospital,CAMS and PUMC,Beijing 100144,China.

Objective To compare the impacts of different nostril on nasotracheal intubation with video laryngoscopy.Methods Totally 120 ASA grade I maxillofacial surgery patients were equally randomized into two groups:group A(left nostril)and group B(right nostril).After rapid induction of anesthesia,the nasal intubation was completed by Tosight video laryngoscope,and the success rate of the first attempt of the tube passing through the nasal cavity was recorded and compared between these two groups. Read More

BMJ Case Rep 2019 Jun 26;12(6). Epub 2019 Jun 26.

Infectious Disease, St. Mary's Hospital, Waterbury, Connecticut, USA.

A 78-year-old woman with no known medical history presented with severe neck pain that began 4 days prior to admission located in the paraspinal cervical region radiating to the shoulders, legs and back. She had associated stiffness of her neck and progression of pain to her jaw and throat with progression to generalised body spasms with lower extremity stiffness and weakness that limited her ability to walk. She quickly developed dysphagia and odynophagia with subsequent generalised spasms and profound hypoxic respiratory failure requiring nasotracheal intubation. Read More

Neuro Endocrinol Lett 2019 Mar;40(1):5-9

Neonatal Department of Intensive Medicine, Faculty of Medicine, Comenius University in Bratislava and Children's Hospital in Bratislava, Slovakia.

Pierre Robin sequence is defined by a triplet of clinical signs in newborns: micrognathia, glossoptosis and tongue-based airway obstruction often accompanied by U-shaped cleft palate. The reported incidence is ranging from 1 to 8.500 to 30. Read More

Oral Maxillofac Surg 2019 Sep 6;23(3):311-315. Epub 2019 Jun 6.

Radiology, HCG Manavata Cancer Centre, Nashik, Nashik, India.

Background: The aim of this study was to conduct a retrospective analysis of modalities of airway management and its impact on patients undergoing head and neck cancer surgeries.

Materials And Methods: A retrospective review of the medical record of 500 patients operated from January 2008 to December 2013 was conducted at our institute. Patients were reviewed for a mode of airway management, a total length of post-operative hospital stay (PLOS), and incidence of elderly patients in the total number of head and neck cancer surgeries posted for various diagnostic and definitive treatments. Read More

Anesth Analg 2020 04;130(4):1018-1025

From the Departments of Anesthesiology and Intensive Care.

Background: Preformed nasal endotracheal tubes (NETs) come with a predefined insertion depth due to their curved design. While size indication refers to internal diameter, there is a considerable variability in the corresponding lengths and proportions of same-sized tubes of different manufacturers which is probably based on the lack of data of nasolaryngeal distances (NLDs) in the adult population. Choosing the best-fitting NET is therefore difficult and carries the risk of endobronchial intubation or, on the contrary, cuff inflation at the vocal cord level. Read More

Can J Anaesth 2019 Oct 29;66(10):1213-1220. Epub 2019 May 29.

Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon, 16499, Korea.

Background: The objective of this study was to determine the clinical usefulness of videolaryngoscopes (VLs) by comparing the time to intubation (TTI) and the ease of intubation of McGrath MAC VL (MVL), Pentax Airway Scope VL (PVL), and Macintosh direct laryngoscope (DL) during nasotracheal intubation using manual in-line stabilization to simulate difficult airways.

Methods: One hundred and twenty patients were randomly assigned to the MVL group (n = 40), the PVL group (n = 40), and the DL group (n = 40). Nasotracheal intubation was performed using MVL, PVL, or DL, according to group assignments. Read More

Oral Maxillofac Surg 2019 Sep 16;23(3):337-341. Epub 2019 May 16.

Otorhinolaryngology-Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.

Objective: To compare submental intubation with tracheostomy in patients with maxillofacial fractures who were operated under general anesthesia and nasotracheal intubation was contraindicated.

Patients And Methods: This prospective comparative study was conducted on 32 patients undergoing maxillofacial operations. All patients had a panfacial trauma (including naso-ethmoid orbital fracture combined with mandibular fracture). Read More

Adv Ther 2019 07 7;36(7):1812-1816. Epub 2019 May 7.

Department of MeSVA, University of L'Aquila, L'Aquila, Italy.

Difficult airway management and intraoperative tube damage are important problems during maxillofacial surgery. Damage occurs frequently during the surgery, and the anesthesiologist must be ready to find a quick and safe solution. Replacing the damaged endotracheal tube involves additional difficulties, and various factors must be evaluated. Read More

Saudi J Anaesth 2019 Apr-Jun;13(2):145-147

Department of Anaesthesia, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, New Delhi, India.

J Clin Anesth 2019 12 17;58:3-4. Epub 2019 Apr 17.

Department of Anaesthesia, Khoo Teck Puat Hospital, Yishun Central 90, Singapore 768828, Singapore.

J Craniofac Surg 2019 Sep;30(6):e533-e535

Division of Oral and Maxillofacial Surgery, College of Dentistry, University of Kentucky, Lexington, KY.

Nasotracheal intubation is routinely used in patients undergoing oral and maxillofacial surgery when intermaxillary fixation is needed either intraoperatively or postoperative. Various complications can occur such as epistaxis, turbinectomy, retropharyngeal dissection, tympanites, and nasal alar pressure sores or necrosis, especially when there is a prolonged nasotracheal intubation. The first report of a nasal alar necrosis after prolonged nasotracheal intubation was published by Hatcher et al in 1968. Read More

J Stomatol Oral Maxillofac Surg 2019 Nov 22;120(5):467-470. Epub 2019 Mar 22.

Department of maxillofacial surgery, university institute of the face and neck, university hospital of Nice, 31, avenue de Valombrose, 06100 Nice, France. Electronic address:

Introduction: Epidermolysis bullosa (EB) is a heterogeneous group of genetic diseases characterized by cutaneous and/or mucosal fragility. Blisters can occur spontaneously or because of minor friction on facial skin or the oral cavity. The repercussions of these dermatoses complicate the management of patients during surgery; for example, wisdom teeth removal might be complicated because of the limited mouth opening and mucosal lesions may be aggravated when the area of the wisdom teeth is being explored. Read More