Alternative Transoral Application of Nasopharyngeal Airways

Transoral application of a nasopharyngeal airway (NPA) is a novel technique for difficult airway management. Clinically, it is an effective alternative for use in nonintubated dental cases under total intravenous anesthesia. This technique can help improve oxygenation and ventilation in clinical situations in which the conventional use of NPAs is ineffective, such as in patients who have findings of obesity; mandibular retrognathia or hypoplasia; maxillary hypoplasia; macroglossia; nasal obstruction secondary to hypertrophic tonsillar, adenoid, and/or lymphoid tissues or nasal polyps; known unusual nasal anatomy (eg, septal deviation); high risk of prolonged epistaxis (eg, patients on anticoagulants); or those who demonstrate mouth-breathing behaviors during deep sedation/nonintubated general anesthesia. After ensuring proper supraglottic placement, the transorally positioned NPA can be further secured with the use of tape for the duration of the dental procedure. Unlike an oropharyngeal airway, this simple and cost-efficient technique facilitates intraoral access for dental treatment.