Using cone-beam CT for appropriate nostril selection in nasotracheal intubation

Area of Science:

• Radiology
• Anesthesiology
• Otorhinolaryngology

Background:

• Nasotracheal intubation is a common procedure with potential complications.
• Nostril selection is critical for successful and safe nasotracheal intubation.
• Current clinical methods for nostril selection may not be fully predictive.

Purpose of the Study:

• To evaluate the predictive value of cone-beam CT (CBCT) for selecting the correct nostril for nasotracheal intubation.
• To determine if CBCT findings can improve nostril selection compared to clinical tests.
• To identify anatomical factors on CBCT that influence intubation success and duration.

Main Methods:

• Sixty patients undergoing maxillofacial surgery with nasotracheal intubation were studied.
• Anesthetists used clinical tests for nostril selection.
• Radiologists analyzed CBCT scans for nasal septum deviation (NSD) and inferior turbinate hypertrophy.
• Intubation success and duration were recorded and analyzed.

Main Results:

• A high success rate (83.3%) was observed for CBCT-guided nostril selections.
• Inferior turbinate hypertrophy was associated with longer intubation durations (P=.031).
• No significant statistical relationship was found between epistaxis and septal deviation (P=.395).

Conclusions:

• Pre-operative CBCT imaging is a valuable tool for assessing anatomical factors influencing nasotracheal intubation.
• CBCT can aid anesthesiologists in selecting the optimal nostril, potentially improving success rates and reducing procedure time.
• Evaluation of septum deviation and turbinate hypertrophy via CBCT is recommended for pre-operative planning.