Nasotracheal intubation (NTI) is the most widely used method to establish an airway during anesthesia for oral surgery. It has the advantage of providing exceptional accessibility and optimal working conditions in the oral cavity for surgeons. Anesthesia providers are highly trained in managing and securing the airway. Because the oral intubation route is the most widely used technique for securing the airway, nasal intubation can be cumbersome for anesthetists who do not routinely perform this skill. Moreover, anesthesia providers who do not routinely perform NTI may feel apprehension out of concern for nasopharyngeal bleeding and trauma. The number of dental and oromaxillofacial procedures requiring nasal intubation has been steadily growing annually. Although NTI is generally safe, it still presents a risk for complications. The purpose of this literature review was to examine current literature and evidence-based practices of NTI to determine whether the use of a catheter-guided technique will improve patient care outcomes by way of decreased trauma to the airway compared to current clinical practices. The goal of this review is to recommend the use of a catheter-guided technique for NTI as the preferred method for securing the airway during oral surgery as it is less traumatizing to the airway than conventional methods.
Nasotracheal intubation (NTI) has the advantage of providing exceptional accessibility as well as an optimal working environment in the oral cavity for the surgeon. Anesthesia providers are highly trained in airway management techniques involving orotracheal and nasotracheal intubations. While NTI is generally safe, it still poses the risk for potential for complications such as nasopharyngeal bleeding and trauma. Other complications that may occur from NTI include: transfer of bacteria from the nasal cavity via the endotracheal tube (ETT), obstruction of the ETT with a foreign object, submucosal laceration, trauma to the middle turbinate, cribriform plate fracture, as well as olfactory nerve damage [
The use of a red rubber catheter-guided technique for NTI was first described in 1979 in a correspondence by MacKinnon and Harrison. The brief report discussed the incidence of trauma during the passage of the endotracheal tube through the nose and pharynx [
Complications as a result of NTI are one of the many contributors to anesthesia-related mortality [
Figures 1-8 Steps of Proper Red-Rubber-Catheter Placement [