Clinical Contribution of CBCT to Pre-Intubation Nasal Passage Assessment in Pediatric Patients: A Retrospective Study

This study aimed to investigate the relationship between nasal anatomical features identified on preoperative cone-beam computed tomography (CBCT) and nostril selection for nasotracheal intubation in pediatric patients undergoing general anesthesia.

CBCT scans of 40 patients aged 8-16 years were evaluated by an oral and maxillofacial radiologist, who measured the shortest bony distance at the inferior meatus, documented septal deviation, inferior turbinate hypertrophy, and dental pathologies, and recommended the nostril deemed most suitable for intubation. Anesthesiologists, blinded to imaging data, performed nasotracheal intubation based solely on clinical assessment. Agreement between radiologist and anesthesiologist choices was analyzed, and logistic regression and ROC analyses were performed to assess the predictive value of nasal diameter differences.

Moderate agreement was observed between the nostril recommended by the radiologist and the nostril selected by the anesthesiologist (Cohen's kappa = 0.497, p = 0.002). Nasal diameter differences significantly predicted radiologist nostril selection (OR = 9.433, 95% CI: 2.388-37.264, p = 0.001). ROC analysis demonstrated moderate discriminative ability (AUC = 0.750, p = 0.017). Anatomical variations, such as septal deviation and inferior turbinate hypertrophy, were common but did not significantly influence anesthesiologists' nostril selection.

Preoperative CBCT scans, even when obtained for dental or surgical purposes, can provide valuable anatomical information to guide nostril selection in pediatric nasotracheal intubation. Evaluation of nasal diameter differences may improve preoperative planning, optimize nostril selection, and potentially reduce intubation-related complications.