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spine injury, can make intubation difficult. Midfacial maxillary fractures may initially require orotracheal intubation for emergency airway management, followed by conversion to NTI to better facilitate proper alignment and surgical fixation. Attempting NTI may cause profuse epistaxis and create a false nasal passage, among many other more serious complications. Under such conditions, performing initial NTI prior to securing the airway orally may be contraindicated. To avoid the complications of NTI, anesthesiologists often use a flexible laryngeal mask

Nasal foreign bodies (NFBs) have the potential to yield significant morbidity. An unusual case of a young child who presented for dental rehabilitation under general anesthesia is described. Immediately prior to the nasotracheal intubation, a foreign body was discovered and retrieved before any considerable injury occurred. This case report highlights the event, discusses the presentation and pathophysiology associated with NFBs, and provides pertinent suggestions for the prevention and management of such an unexpected incident. CASE

In conventional nasal intubation, a tracheal tube is gently introduced into the nostril, followed by direct laryngoscopy. If the glottis cannot be visualized or the tube does not enter the glottis, the patient's head may be extended or flexed, or use of Magill forceps may be required. 1 However, despite multiple attempts, occasionally the tube cannot be passed into the trachea because the tip of the nasotracheal tube does not advance anteriorly into the larynx and trachea but courses posteriorly into the esophagus, or it could be

CASE PRESENTATION A 54-year-old woman (height 155 cm; weight 54 kg; body mass index 22.5 kg/m 2 ) was scheduled to undergo right partial glossectomy to treat squamous cell carcinoma of the tongue. Upon admission 2 days before surgery, the patient reported for the first time to the consulting anesthesiologist that she had undergone nasal surgery 20 years earlier. Although the patient did not have any subjective symptoms, the details of the prior nasal surgery were unknown. The anesthesiologist determined that it may impede nasotracheal

After 2-jaw surgery, difficulty in breathing through the mouth and the nose is frequently observed due to nasal airway obstruction, edema of lips, cheeks, and tongue, intraoral bleeding, and sometimes maxillo-mandibular fixation. The nasopharyngeal airway (NPA) is usually inserted to facilitate breathing, tamponade nasal bleeding if present, and provide supplemental oxygen after extubation. The NPA is preferable in patients with limited mouth opening or those lightly anesthetized. 1 It is known to be useful for oxygen administration after

The nasal intubation technique first described in 1902 by Kuhn 1 has been the most commonly desired method of intubation for most maxillofacial surgical procedures. It is paramount for the anesthesiologist to have a strong foundation in the nasal anatomy to adequately understand the pathways of the endotracheal tube (ETT) and the associated complications during nasotracheal intubation. 1 Each patient is thoroughly assessed and examined to determine the potential risks to nasotracheal intubation versus oral intubation. The reported