Retrograde intubation through nasal route in patients with limited mouth opening undergoing oral and maxillofacial surgery

Vadepally, Ashwant Kumar; Sinha, Ramen; Kumar, Anil

doi:10.1016/j.jobcr.2017.08.002

Cited by 4 publications

(3 citation statements)

References 26 publications

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“…Vadepally et al conducted a comparative study to test intubation through the nasal route in patients with a limited mouth opening of <2 cm. 12 In this study, 18 patients required maxillofacial surgical procedures to increase mouth opening. Indications for this technique were mandibular fracture (n=6), oral submucous fibrosis (n=6), temporomandibular joint (TMJ) ankylosis (n=4), and internal derangement of the TMJ (n=2).…”

Section: Discussionmentioning

confidence: 97%

Capnography-assisted airway management by awake blind nasal intubation in maxillofacial surgeries: An observational study

Kokate,

Vikram Kokate,

Gaurav Dubey

et al. 2024

Asian J Med Sci

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Background: Maxillofacial surgery patients frequently pose challenges to airway management due to anatomical and functional constraints. While fiber-optic-aided nasotracheal intubation is considered the gold standard, not all medical facilities have access to fiber-optic bronchoscopes, particularly in low-resource settings. In such situations, awake nasal tracheal intubation is often the safest approach for managing patients with known or suspected difficult airways. Aims and Objectives: (1) To assess the technique of capnography-assisted airway management by awake blind nasal intubation (ABNI) in maxillofacial surgeries. (2) To find out any complications encountered by the technique of capnography-assisted airway management by ABNI in maxillofacial surgeries. Materials and Methods: 40 patients undergoing various maxillofacial surgeries and in whom blind nasotracheal intubation was attempted were included in this study. The institutional ethical committee approved the study, and informed consent was obtained from all the patients. The number of attempts for ABNI, successful versus failed ABNI, and complications encountered were studied. SSPS 21.0 software was used for statistical analysis. Results: There were 23 (57.50%) males and 17 (42.50%) females. There was a male preponderance, with the M: F ratio being 1:0.73. The mean age of the patients was 40.97±8.92 years. In 36 (90%) of the patients, the intubation could be successfully done. In 19 (47.50%) patients, blind nasal intubation was successfully done in the first attempt; 2 attempts were required in 15 (37.50%) patients, and 3 attempts were required in 2 (5%) patients. Epistaxis (10%) and sore throats (7.5%) were the most common complications in the studied cases. Conclusion: Capnography-assisted ABNI is an effective technique for airway control in patients undergoing maxillofacial surgeries with an acceptable complication rate.

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Section: Discussionmentioning

confidence: 97%

Capnography-assisted airway management by awake blind nasal intubation in maxillofacial surgeries: An observational study

Kokate,

Vikram Kokate,

Gaurav Dubey

et al. 2024

Asian J Med Sci

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“…Further studies should evaluate if alternative intubation techniques are not being utilized due to (1) the lack of further TMJ evaluation and therefore the need is not considered, (2) the focus is only on an optimal intubating condition, or (3) other techniques are not feasible and/or availabel such as the retrograde nasotracheal intubation. This technique was found to be effective for patients with limited mouth opening [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…According to Agro et al, [ 3 ] this will allow the anesthesia providers to choose the best intubation technique and to reduce the risk of the new onset of TMJ issues, or the worsening of misdiagnosed TMD after intubation. For instance, the retrograde nasotracheal intubation was found to be an effective and useful technique for airway control in patients with limited mouth opening [ 14 ]. However, no studies have been performed to evaluate if the anesthesia providers are actually evaluating TMJ status prior and after anesthesia with intubation, or if different intubation procedures are being selected based on the patient’s signs and symptoms, including limited mouth opening.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Temporomandibular Joint by Anesthetists in Florida When Conducting Orotracheal Intubation—A Pilot Study

Gadotti

Geronimo

Rodríguez

et al. 2020

JCM

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Background: Orotracheal intubation has been considered a risk factor for the development or exacerbation of disorders related to the temporomandibular joint (TMJ). The objective of this pilot study was to evaluate TMJ assessment performed by anesthetists in Florida when conducting orotracheal intubation. Methods: An online questionnaire was created using Qualtrics. The survey included 22 questions related to demographics, TMJ related to anesthesia procedures, and education/awareness regarding TMJ related to intubation. Descriptive statistics and cross-tabulation analysis were performed. Results: One hundred and eight providers participated (mean 46 years-old ± 12; 59% female). About 50% reported to always evaluate TMJ prior non-emergency intubation. Of those, 56% used an alternative intubation technique based on the TMJ status and 60% never/rarely evaluated TMJ post-intubation. Twenty-five percent reported they did not know of possible intubation effects on TMJ and 47% reported that they did not receive adequate information/education on TMJ management related to intubation in school. After participation, 81% reported to be more aware of the importance of evaluating TMJ. Conclusions: Only half of the providers who frequently performed intubation in Florida evaluated TMJ prior to intubation. This survey increased the awareness regarding the importance of evaluating TMJ when conducting intubation. This may contribute to reducing TMJ issues associated with non-emergency intubations.

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Unconventional Intubation Techniques

Ramkiran

Bidkar

2023

The Airway Manual

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Retrograde intubation through nasal route in patients with limited mouth opening undergoing oral and maxillofacial surgery

Abstract: In conclusion, retrograde nasotracheal intubation is an effective and useful technique for airway control in patients with LMO and with only a small risk potential.

Cited by 4 publications

References 26 publications

Capnography-assisted airway management by awake blind nasal intubation in maxillofacial surgeries: An observational study

Capnography-assisted airway management by awake blind nasal intubation in maxillofacial surgeries: An observational study

Evaluation of Temporomandibular Joint by Anesthetists in Florida When Conducting Orotracheal Intubation—A Pilot Study

Unconventional Intubation Techniques

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