Complications of nasotracheal intubation

For a two-month period, 71 nasotracheal intubations done in the emergency department or inpatient units at Detroit General Hospital were studied. Sixty-five of 71 intubations, or 91%, were successful. Mild or moderate complications occurred in 15 of 71 patients, and consisted of mild or moderate bleeding. Moderate to severe complications occurred in seven of 71 patients, and consisted of severe bleeding and retropharyngeal perforation. Retropharyngeal perforation may be a more common complication of nasotracheal intubation than realized. The major technical error is failure to appreciate that loss of flow of air from the tube, once the tube has passed the turbinates, means that the lumen of the tube is abutting the pharyngeal mucosa. Even slight pressure at this point can lead to retropharyngeal perforation.