Common Nasal Anomalies and Its Implications on Intubation in Head and Neck Surgeries

Ganesh Elumalai; Sushma Chodisetty; Sanjoy Sanyal

doi:doi:10.11648/j.js.20160404.11

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Common Nasal Anomalies and Its Implications on Intubation in Head and Neck Surgeries

Ganesh Elumalai, Sushma Chodisetty, Sanjoy Sanyal

Published in Journal of Surgery (Volume 4, Issue 4)

Received: 16 June 2016 Accepted: 24 June 2016 Published: 18 July 2016

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Abstract

Nasotracheal intubation used to be the preferred route for prolonged intubation in critical care units. Nasotracheal intubation may sometimes cause nasal trauma. The study included one hundred and nine (109) adult patients, were scheduled for elective head and neck surgeries with general anaesthesia, requiring nasotracheal intubation. All the patients compiled the criteria of American Society of Anesthesiologists (ASA) physical status I and II were included in this study. The incidence of complicated laryngoscopy was assumed as 8%, confidence levels at 99% and an error of 3%, the total sample size were One hundred and three (103) patients. Observation, recorded bleeding 63.11% (65-patients) of the time with the literature stating epistaxis rates from 17-77%. The study found there was a significant relationship of soft tissue profile and number of intubation attempts. In this study a concave profile was more likely to have multiple attempts, there was a significant relationship between moderate and severe bleeding and number of intubation attempts and in 04.85% (05-patients) of those patients with severe bleeding there were multiple intubation attempts. Thyromental distance and Mallampati score did not seem to have a significant relationship with either the number of intubation attempts or severity of bleeding. This may demonstrate that multiple attempts led to an increase in bleeding due to increased trauma or that bleeding from the nose into the oropharnyx and hypo-pharynx contributed to a difficult view of the larynx for passing the tube between the cords. The clinical relevance from this study to create an algorithm or define a set of factors to alert anesthetists to aware of knowledge about the common nasal anomalies for the difficult nasotracheal (NT) intubation.

Published in	Journal of Surgery (Volume 4, Issue 4)
DOI	10.11648/j.js.20160404.11
Page(s)	81-84
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Nasotracheal Intubation, Dental Surgeries, Oral Surgeries, Nasal Anomalies

References

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[2]	Scamman FL, Babin R. W. An unusual complication of nasotracheal intubation. Anesthesiology 1983; 59: 352-3.
[3]	Wilkinson JA, Mathis RD, Dire DJ. Turbinate destruction: a rare complication of nasotracheal intubation. J Emerg Med 1986; 4: 209.
[4]	Cooper R. Bloodless turbinectomy following blind nasal intubation. Anesthesiology 1989; 71: 469.
[5]	Kuo MJ, Reid AP, Smith JE. Unilateral nasal obstruction: an unusual presentation of a complication of nasotracheal intubation. J Laryngol Otol 1994; 108: 991-2.
[6]	Bandy DP, Theberge DM, Richardson DD. Obstruction of nasotracheal tube by inferior turbinate. Anesth Prog 1991; 38: 27-8.
[7]	Smith JE, Reid AP. Asymptomatic intranasal abnormalities influencing the choice of nostril for nasotracheal intubation. Br J Anaesth 1999; 83: 882-6.
[8]	Smith JE, Reid AP. Asymptomatic intranasal abnormalities influencing the choice of nostril for nasotracheal intubation. B J Anaesth. 1999; 83: 882–886.
[9]	Ahmed Nusrath A, Tong JL, Smith JE. Pathways through the nose for nasal intubation: a comparison of three endotracheal tubes. B J Anaesth. 2007; 100: 269–274.
[10]	Prakash S, Rapsang AG, Mahajan S, Bhattacharjee S, Singh R, Gogia AR. Comparative Evaluation of the Sniffing Position with Simple Head Extension for Laryngoscopic View and Intubation Difficulty in Adults Undergoing Elective Surgery. Anesthesiol Res Pract. 2011. 2011 297913.
[11]	Samsoon GL, Young JR. Difficult tracheal intubation: A retrospective study. Anaesthesia. 1987;42: 487–90.
[12]	Wilson ME, Spiegelhalter D, Robertson JA, Lesser P. Predicting difficult intubation. Br J Anaesth. 1988;61: 211–6.
[13]	Ramadhani SA, Mohamed LA, Rocke DA, Gouws E. Sternomental distance as the sole predictor of difficult laryngoscopy in obstetric anaesthesia. Br J Anaesth. 1996;77: 312–6.
[14]	Tintinalli, Judith E., Claffey, James. Complications of nasotracheal intubation. Annals of Emergency Medicine Annals of Emergency Medicine, 1981; 10 (3): 142-144.
[15]	Watt S, Pickhardt D, Lerman J, Armstrong J, Creighton PR, Feldman L. Telescoping tracheal tubes into catheters minimizes epistaxis during nasotracheal intubation in children. Anesthesiology. 2007; 106 (2): 238-42.
[16]	Prior S, Heaton J, Jatana KR, Rashid RG. Parker flex-tip and standard-tip endotracheal tubes: A comparison during nasotracheal intubation. Anesthesia Progress. 2010; 57 (1): 18-24.

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APA Style

Ganesh Elumalai, Sushma Chodisetty, Sanjoy Sanyal. (2016). Common Nasal Anomalies and Its Implications on Intubation in Head and Neck Surgeries. Journal of Surgery, 4(4), 81-84. https://doi.org/10.11648/j.js.20160404.11

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ACS Style

Ganesh Elumalai; Sushma Chodisetty; Sanjoy Sanyal. Common Nasal Anomalies and Its Implications on Intubation in Head and Neck Surgeries. J. Surg. 2016, 4(4), 81-84. doi: 10.11648/j.js.20160404.11

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AMA Style

Ganesh Elumalai, Sushma Chodisetty, Sanjoy Sanyal. Common Nasal Anomalies and Its Implications on Intubation in Head and Neck Surgeries. J Surg. 2016;4(4):81-84. doi: 10.11648/j.js.20160404.11

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@article{10.11648/j.js.20160404.11,
  author = {Ganesh Elumalai and Sushma Chodisetty and Sanjoy Sanyal},
  title = {Common Nasal Anomalies and Its Implications on Intubation in Head and Neck Surgeries},
  journal = {Journal of Surgery},
  volume = {4},
  number = {4},
  pages = {81-84},
  doi = {10.11648/j.js.20160404.11},
  url = {https://doi.org/10.11648/j.js.20160404.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20160404.11},
  abstract = {Nasotracheal intubation used to be the preferred route for prolonged intubation in critical care units. Nasotracheal intubation may sometimes cause nasal trauma. The study included one hundred and nine (109) adult patients, were scheduled for elective head and neck surgeries with general anaesthesia, requiring nasotracheal intubation. All the patients compiled the criteria of American Society of Anesthesiologists (ASA) physical status I and II were included in this study. The incidence of complicated laryngoscopy was assumed as 8%, confidence levels at 99% and an error of 3%, the total sample size were One hundred and three (103) patients. Observation, recorded bleeding 63.11% (65-patients) of the time with the literature stating epistaxis rates from 17-77%. The study found there was a significant relationship of soft tissue profile and number of intubation attempts. In this study a concave profile was more likely to have multiple attempts, there was a significant relationship between moderate and severe bleeding and number of intubation attempts and in 04.85% (05-patients) of those patients with severe bleeding there were multiple intubation attempts. Thyromental distance and Mallampati score did not seem to have a significant relationship with either the number of intubation attempts or severity of bleeding. This may demonstrate that multiple attempts led to an increase in bleeding due to increased trauma or that bleeding from the nose into the oropharnyx and hypo-pharynx contributed to a difficult view of the larynx for passing the tube between the cords. The clinical relevance from this study to create an algorithm or define a set of factors to alert anesthetists to aware of knowledge about the common nasal anomalies for the difficult nasotracheal (NT) intubation.},
 year = {2016}
}

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TY  - JOUR
T1  - Common Nasal Anomalies and Its Implications on Intubation in Head and Neck Surgeries
AU  - Ganesh Elumalai
AU  - Sushma Chodisetty
AU  - Sanjoy Sanyal
Y1  - 2016/07/18
PY  - 2016
N1  - https://doi.org/10.11648/j.js.20160404.11
DO  - 10.11648/j.js.20160404.11
T2  - Journal of Surgery
JF  - Journal of Surgery
JO  - Journal of Surgery
SP  - 81
EP  - 84
PB  - Science Publishing Group
SN  - 2330-0930
UR  - https://doi.org/10.11648/j.js.20160404.11
AB  - Nasotracheal intubation used to be the preferred route for prolonged intubation in critical care units. Nasotracheal intubation may sometimes cause nasal trauma. The study included one hundred and nine (109) adult patients, were scheduled for elective head and neck surgeries with general anaesthesia, requiring nasotracheal intubation. All the patients compiled the criteria of American Society of Anesthesiologists (ASA) physical status I and II were included in this study. The incidence of complicated laryngoscopy was assumed as 8%, confidence levels at 99% and an error of 3%, the total sample size were One hundred and three (103) patients. Observation, recorded bleeding 63.11% (65-patients) of the time with the literature stating epistaxis rates from 17-77%. The study found there was a significant relationship of soft tissue profile and number of intubation attempts. In this study a concave profile was more likely to have multiple attempts, there was a significant relationship between moderate and severe bleeding and number of intubation attempts and in 04.85% (05-patients) of those patients with severe bleeding there were multiple intubation attempts. Thyromental distance and Mallampati score did not seem to have a significant relationship with either the number of intubation attempts or severity of bleeding. This may demonstrate that multiple attempts led to an increase in bleeding due to increased trauma or that bleeding from the nose into the oropharnyx and hypo-pharynx contributed to a difficult view of the larynx for passing the tube between the cords. The clinical relevance from this study to create an algorithm or define a set of factors to alert anesthetists to aware of knowledge about the common nasal anomalies for the difficult nasotracheal (NT) intubation.
VL  - 4
IS  - 4
ER  -

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Author Information

Ganesh Elumalai

Department of Anatomy & Neuroscience, College of Medicine, Texila American University, Georgetown, South America
Sushma Chodisetty

Department of Casualty, National Medical College and Teaching Hospital, Tribhuvan University, Birgunj, Nepal
Sanjoy Sanyal

Department of Neuroscience, College of Medicine, Texila American University, Georgetown, South America

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APA Style

Ganesh Elumalai, Sushma Chodisetty, Sanjoy Sanyal. (2016). Common Nasal Anomalies and Its Implications on Intubation in Head and Neck Surgeries. Journal of Surgery, 4(4), 81-84. https://doi.org/10.11648/j.js.20160404.11

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ACS Style

Ganesh Elumalai; Sushma Chodisetty; Sanjoy Sanyal. Common Nasal Anomalies and Its Implications on Intubation in Head and Neck Surgeries. J. Surg. 2016, 4(4), 81-84. doi: 10.11648/j.js.20160404.11

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AMA Style

Ganesh Elumalai, Sushma Chodisetty, Sanjoy Sanyal. Common Nasal Anomalies and Its Implications on Intubation in Head and Neck Surgeries. J Surg. 2016;4(4):81-84. doi: 10.11648/j.js.20160404.11

Copy | Download

@article{10.11648/j.js.20160404.11,
  author = {Ganesh Elumalai and Sushma Chodisetty and Sanjoy Sanyal},
  title = {Common Nasal Anomalies and Its Implications on Intubation in Head and Neck Surgeries},
  journal = {Journal of Surgery},
  volume = {4},
  number = {4},
  pages = {81-84},
  doi = {10.11648/j.js.20160404.11},
  url = {https://doi.org/10.11648/j.js.20160404.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20160404.11},
  abstract = {Nasotracheal intubation used to be the preferred route for prolonged intubation in critical care units. Nasotracheal intubation may sometimes cause nasal trauma. The study included one hundred and nine (109) adult patients, were scheduled for elective head and neck surgeries with general anaesthesia, requiring nasotracheal intubation. All the patients compiled the criteria of American Society of Anesthesiologists (ASA) physical status I and II were included in this study. The incidence of complicated laryngoscopy was assumed as 8%, confidence levels at 99% and an error of 3%, the total sample size were One hundred and three (103) patients. Observation, recorded bleeding 63.11% (65-patients) of the time with the literature stating epistaxis rates from 17-77%. The study found there was a significant relationship of soft tissue profile and number of intubation attempts. In this study a concave profile was more likely to have multiple attempts, there was a significant relationship between moderate and severe bleeding and number of intubation attempts and in 04.85% (05-patients) of those patients with severe bleeding there were multiple intubation attempts. Thyromental distance and Mallampati score did not seem to have a significant relationship with either the number of intubation attempts or severity of bleeding. This may demonstrate that multiple attempts led to an increase in bleeding due to increased trauma or that bleeding from the nose into the oropharnyx and hypo-pharynx contributed to a difficult view of the larynx for passing the tube between the cords. The clinical relevance from this study to create an algorithm or define a set of factors to alert anesthetists to aware of knowledge about the common nasal anomalies for the difficult nasotracheal (NT) intubation.},
 year = {2016}
}

Copy | Download

TY  - JOUR
T1  - Common Nasal Anomalies and Its Implications on Intubation in Head and Neck Surgeries
AU  - Ganesh Elumalai
AU  - Sushma Chodisetty
AU  - Sanjoy Sanyal
Y1  - 2016/07/18
PY  - 2016
N1  - https://doi.org/10.11648/j.js.20160404.11
DO  - 10.11648/j.js.20160404.11
T2  - Journal of Surgery
JF  - Journal of Surgery
JO  - Journal of Surgery
SP  - 81
EP  - 84
PB  - Science Publishing Group
SN  - 2330-0930
UR  - https://doi.org/10.11648/j.js.20160404.11
AB  - Nasotracheal intubation used to be the preferred route for prolonged intubation in critical care units. Nasotracheal intubation may sometimes cause nasal trauma. The study included one hundred and nine (109) adult patients, were scheduled for elective head and neck surgeries with general anaesthesia, requiring nasotracheal intubation. All the patients compiled the criteria of American Society of Anesthesiologists (ASA) physical status I and II were included in this study. The incidence of complicated laryngoscopy was assumed as 8%, confidence levels at 99% and an error of 3%, the total sample size were One hundred and three (103) patients. Observation, recorded bleeding 63.11% (65-patients) of the time with the literature stating epistaxis rates from 17-77%. The study found there was a significant relationship of soft tissue profile and number of intubation attempts. In this study a concave profile was more likely to have multiple attempts, there was a significant relationship between moderate and severe bleeding and number of intubation attempts and in 04.85% (05-patients) of those patients with severe bleeding there were multiple intubation attempts. Thyromental distance and Mallampati score did not seem to have a significant relationship with either the number of intubation attempts or severity of bleeding. This may demonstrate that multiple attempts led to an increase in bleeding due to increased trauma or that bleeding from the nose into the oropharnyx and hypo-pharynx contributed to a difficult view of the larynx for passing the tube between the cords. The clinical relevance from this study to create an algorithm or define a set of factors to alert anesthetists to aware of knowledge about the common nasal anomalies for the difficult nasotracheal (NT) intubation.
VL  - 4
IS  - 4
ER  -

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