Using of panoramic and posteroanterior cephalometric radiographs to identify the optimal nasal passage for nasotracheal intubation.

Background and Aim: Selecting the optimum nasal passage for nasotracheal intubation is quite important in the maxillofacial surgeries for the success of intubation and the reduction of potential complications such as nasal mucosal laceration, epistaxis, avulsion of the inferior and middle turbinates, and septal laceration. Materials and Methods: The present study evaluates standard panoramic radiographs (PR) and posteroanterior cephalometric radiographs (PACR) to determine the optimal nasal passage for nasotracheal intubation and compares the results with those of routine anesthesiological occlusion and spatula tests (ST). The results of occlusion tests (OT), ST, and radiological assessments of 60 patients prior to nasotracheal intubation were compared with the nasal endoscopic assessment results, and complications were evaluated. Results: There was no significant association between the OT and nasal endoscopy results (P = 0.075). A significant association was found between the ST and nasal endoscopy results (P = 0.000), and between the radiological assessments and the nasal endoscopy results (P = 0.000). Compatibility with nasal endoscopy was 54% when the occlusion and ST were evaluated together, 75% when the OT and radiological assessments were evaluated together, and 86% when the ST and radiological assessments were evaluated together. The highest level of compatibility was 92% when all the tests were evaluated together. Conclusion: The simple tests alone were found to be inadequate for the selection of the optimal nasal passage. Evaluation of PR and PACR, which are commonly used in maxillofacial surgeries, together with simple anesthesiological examination tests would increase nasotracheal intubation success and decrease complications.

Nasotracheal intubation performance with the mcgrath videolaryngoscope versus macintosh laryngoscope in oral and maxillofacial surgery- An observational study.

Background and Aim: Nasotracheal intubation is the main route to secure the airway in oral and maxillofacial surgery patients. This study was aimed to compare the intubation times and glottis visualization of McGrath video laryngoscope with the Macintosh laryngoscope for routine nasotracheal intubation. Materials and Methods: Records of seventy-one ASA (American Society of Anesthesiologists) I-II patients were evaluated and allocated into two groups (McGrath video laryngoscope (VL) and Macintosh groups). Intubation times, modified intubation difficulty scale (MIDS) scores, and hemodynamic parameters (heart rate and mean arterial pressure) were compared after the anesthesia induction and the intubation. Results: Mean intubation time in the McGrath group (24.9 ± 5.9 seconds) was significantly lower than that of the Macintosh group (28 ± 6.2 seconds; P = 0.037). Magill forceps were needed less in the McGrath group compared to the Macintosh group (13.89% vs. 42.86%; P = 0.009). Total MIDS scores were similar (P = 0.778). There was no significant difference in the hemodynamic parameters between the groups. Conclusion: The McGrath VL significantly reduced the intubation time and the use of Magill forceps compared with Macintosh direct laryngoscope and can be utilised effectively for routine nasotracheal intubation.