Pathological changes associated with short-term nasal intubation

In order to define the incidence and anatomical site of nasal damage following nasotracheal intubation, we investigated 100 consecutive patients undergoing dental extractions under general anaesthesia. Patients were questioned pre-operatively about the physiological function of their noses and examined by anterior rhinoscopy for anatomical abnormalities. Examinations were repeated postoperatively, looking specifically for haemorrhage, mucosal tears and septal and turbinate disruption. Minor bruising was common (54%) and most frequently involved mucosa overlying the inferior turbinate and adjacent septum. In two cases bruising involved the middle turbinate. There was no relationship between the number of attempts at intubation and subsequent damage. Pre-operative otolaryngological assessment failed to identify those patients who subsequently proved difficult or impossible to intubate nasally and incorrectly predicted difficulty in 11 patients who had pre-existing deviation of the nasal septum. In conclusion, short-term nasotracheal intubation was not associated with significant nasal morbidity, and pre-operative anatomical assessment failed to identify those in whom nasal intubation proved difficult or impossible.