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Nasotracheal Intubation Using the Airtraq Versus Macintosh Laryngoscope: A Manikin Study
Yoshihiro HirabayashiMD and
Norimasa SeoMD
Article Category: Research Article
Volume/Issue: Volume 55: Issue 3
Online Publication Date: Jan 01, 2008
DOI: 10.2344/0003-3006-55.3.78
Page Range: 78 – 81

Nasotracheal intubation often is required for dental and oral surgery. Direct laryngoscopy with the Macintosh laryngoscope, including the use of Magill forceps, is the most widely used method for nasotracheal intubation. However, this method is somewhat difficult to master, especially by novice personnel who do not perform nasotracheal intubation frequently. The Airtraq laryngoscope (Prodol Meditec, Vizcaya, Spain) is a new intubation device that provides a view of the glottic opening without aligning the oral, pharyngeal, and

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Dual Bougie Technique for Nasotracheal Intubation
Rasjesh MahajanMD,
Parvaiz AhmedMD,
Firdose ShafiMD, and
Rishab BassiMD
Article Category: Research Article
Volume/Issue: Volume 59: Issue 2
Online Publication Date: Jan 01, 2012
DOI: 10.2344/11-09.1
Page Range: 85 – 86

In the case of unanticipated difficult airway, nasotracheal intubation can prove hazardous. Epistaxis is a common complication of nasotracheal intubation if a large, unsoftened tube is used, and the blood can interfere with visualization and securing of the airway with conventional techniques. Piepho et al 1 advocate to “ look before you leap ” prior to nasotracheal intubation, ie, to assess the airway by direct laryngoscopy prior to passing a tracheal tube through the nares. The tracheal tube should be passed through nares only in patients with Cormack

Figure 3; Lateral radiographs of the manikin taken during nasotracheal intubation. ETT indicates tip of an endotracheal tube; M, tip of the Macintosh blade; A, tip of the Airtraq; and *, vocal cords. (a) The endotracheal tube was nasally advanced in the pharynx before laryngoscopy. (b) Intubation with the Macintosh laryngoscope. The Macintosh laryngoscope significantly elevates the glottis; consequently, the nasally introduced tube slides upward and then downward in sequence. To align the tube tip with the glottic inlet, the Magill forceps is often used. (c) Intubation with the Airtraq. The Airtraq laryngoscope preserves the configuration of the airway in its original position. Pushing the nasally introduced tube allows it to advance smoothly into the glottic inlet.
Yoshihiro Hirabayashi and
Norimasa Seo
Figure 3
Figure 3

Lateral radiographs of the manikin taken during nasotracheal intubation. ETT indicates tip of an endotracheal tube; M, tip of the Macintosh blade; A, tip of the Airtraq; and *, vocal cords. (a) The endotracheal tube was nasally advanced in the pharynx before laryngoscopy. (b) Intubation with the Macintosh laryngoscope. The Macintosh laryngoscope significantly elevates the glottis; consequently, the nasally introduced tube slides upward and then downward in sequence. To align the tube tip with the glottic inlet, the Magill forceps is often used. (c) Intubation with the Airtraq. The Airtraq laryngoscope preserves the configuration of the airway in its original position. Pushing the nasally introduced tube allows it to advance smoothly into the glottic inlet.

Thermophysical Properties of Thermosoftening Nasotracheal Tubes
Yoshihiro TakasugiDDS, PhD,
Koichi FutagawaMD, PhD,
Takashi UmedaPhD,
Kouhei KazuharaME, and
Satoshi MorishitaMS
Article Category: Research Article
Volume/Issue: Volume 65: Issue 2
Online Publication Date: Jan 01, 2018
DOI: 10.2344/anpr-65-02-06
Page Range: 100 – 105

Epistaxis has been reported as the most common complication of nasotracheal intubation. The incidence of epistaxis has been generally reported as ranging from 50 to 80%. 1 – 5 During nasotracheal intubation, the tip of the tube advances through the narrow nasal passages, reaches the posterior nasopharyngeal wall, and changes direction downward to the oropharynx. Epistaxis usually occurs from damage to Kiesselbach's plexus in Little's area in the anterior part of the nasal septum. 6 Although bruising of the mucosa overlying the turbinate

Comparing Video and Direct Laryngoscopy for Nasotracheal Intubation
Brett J. KingDDS,
Ira PadnosMD,
Kenneth MancusoMD, and
Brian J. ChristensenDDS, MD
Article Category: Research Article
Volume/Issue: Volume 67: Issue 4
Online Publication Date: Dec 31, 2020
DOI: 10.2344/anpr-67-02-08
Page Range: 193 – 199

Nasotracheal intubation is a common method for securing an airway during surgical procedures involving the orofacial complex. The placement of a nasotracheal tube is often more challenging than oral intubation, especially for providers who are in training or those with less experience, even for patients with normal airway anatomy. Video laryngoscopy is an adjunctive technique in anesthesia that utilizes a camera at the tip of the laryngoscope blade, which provides an indirect view of the glottis and surrounding structures during intubation

Partially Withdrawn Nasotracheal Tube: An Alternative to the Nasal Trumpet
Yong Hee ParkMD, MSD,
Young Jun ChoiDDS, PhD,
Won Cheul ChoiDDS, PhD, and
Ui Lyong LeeDDS, MSD
Article Category: Research Article
Volume/Issue: Volume 62: Issue 4
Online Publication Date: Jan 01, 2015
DOI: 10.2344/15-00013.1
Page Range: 166 – 167

suction to be done with minimal discomfort by passing a suction catheter through the shortened ETT. Figure 1. Nasotracheal tube (Mallinckrodt RAE) was partially withdrawn after deflating the cuff. Figure 1. Nasotracheal tube (Mallinckrodt RAE) was partially withdrawn after deflating the cuff. Figure 2. The standard adaptor supplied with the nasotracheal tube was reinserted into the proximal end. Figure 2. The standard adaptor supplied

Thermosoftening of the Parker Flex-TipTM Tracheal Tube in Preparation for Nasotracheal Intubation
Takuro SanukiDDS, PhD and
Junichiro KotaniDDS, PhD
Article Category: Other
Volume/Issue: Volume 60: Issue 3
Online Publication Date: Jan 01, 2013
DOI: 10.2344/0003-3006-60.3.109
Page Range: 109 – 110

Nasal intubation is often required for dental and oral surgical procedures to facilitate complete surgical access to the oral cavity. Various complications resulting from nasotracheal intubation have been reported. However, the most common complication of nasotracheal intubation remains nasal epistaxis. 1 The incidence of nasal epistaxis is high, ranging from 18 to 77%. 2 The Parker Flex-Tip tracheal tube (PFTT, Parker Medical, Highlands Ranch, Colo) has a soft, flexible, curved tip with double Murphy eyes. Prior et al 3 reported

Acute Management of Massive Epistaxis After Nasotracheal Extubation
Kanta KidoDDS, PhD,
Yuki ShindoDDS,
Hitoshi MiyashitaDDS, PhD,
Mikio KusamaDDS, PhD,
Shigekazu SuginoMD, PhD, and
Eiji MasakiMD, PhD
Article Category: Case Report
Volume/Issue: Volume 66: Issue 4
Online Publication Date: Jan 01, 2019
DOI: 10.2344/anpr-66-02-09
Page Range: 211 – 217

Epistaxis is one of the most common complications of nasotracheal intubation. 1 – 3 Various methods have been developed to prevent or reduce bleeding, including thermosoftening of the nasal endotracheal tube as well as use of the gum elastic bougie technique. 4 – 6 However, management of massive epistaxis after nasotracheal extubation has not been well addressed, even in reviews of nasotracheal intubation for head and neck surgery. 1 , 3 Depending on the surgical procedure, epistaxis may be more complicated and difficult to control

Alternative Methods for Nasotracheal Intubation and Extubation in a Patient With Apert Syndrome
Masanori TsukamotoDDS, PhD and
Takeshi YokoyamaDDS, PhD
Article Category: Research Article
Volume/Issue: Volume 62: Issue 3
Online Publication Date: Jan 01, 2015
DOI: 10.2344/0003-3006-62.3.122
Page Range: 122 – 124

In cases with congenital anomaly in the oral and maxillofacial region, procedures for corrective surgery frequently require nasotracheal intubation for optimal surgical access and to secure the airway. Reports in patients with Apert syndrome revealed airway concerns including stiff or vertically fused tracheal rings, macroglossia, and tonsillar and adenoid hypertrophy. 1 In addition, it has also been reported that the nasotracheal tube, when it is advanced through narrow nasal passages, may injure the nasal tissue and/or be inserted into

Risk Factors for Postoperative Sore Throat After Nasotracheal Intubation
Masanori TsukamotoDDS, PhD,
Shiori TauraDDS,
Sayuri KadowakiDDS, PhD,
Takashi HitosugiDDS, PhD,
Yoichiro MikiPhD, and
Takeshi YokoyamaDDS, PhD
Article Category: Research Article
Volume/Issue: Volume 69: Issue 3
Online Publication Date: Oct 06, 2022
DOI: 10.2344/anpr-69-01-05
Page Range: 3 – 8

Postoperative sore throat is a common complication following general anesthesia with orotracheal intubation. It has been reported as one of the most undesirable postoperative outcomes and may influence patient satisfaction the most. 1 – 4 However, there is very little information regarding postoperative sore throat following nasotracheal intubation, 1 which may be accomplished directly or indirectly. Direct laryngoscopy is widely used tracheal intubation 5 – 7 ; however, difficult and failed intubations still occur. 6 , 8 , 9 Difficulty