Clinico-Radiological Assesment of Nasal Morphological Parameters in Determining Choice of Nostril Side to Achieve Unhindered Nasal Passage in Nasoendotracheal Intubation of Maxillofacial Surgical Patients: A Randomized Control Trial

Abstract

Background: A significant number of patients undergoing maxillofacial surgery need naso-endotracheal intubation. However, in many patients who are in need of oral and maxillofacial surgical procedures under general anesthesia have nasal obstructions undiagnosed, which render airway selection and management difficult. Hence role of nasal morphological parameters to select nostril side is essential for selection of nostril side for an unhindered nasal passage in naso-endotracheal intubation.

Material and methods: A total of 50 patients, aged between 18-60 years, requiring naso-endotracheal intubation for maxillofacial surgery were included in the study. Two groups of 25 each were made, group A: Pre anesthetic nasal evaluation with blinding and group B: Pre anesthetic nasal evaluation without blinding. Patients were evaluated clinically and radiologically for the presence of septal deviations, septal spurs, epistaxis, nasal polyps and enlarged adenoids in nasal passage both pre and intra operatively. Pre-op and intra-op assessment was done and evaluated on basis of the XIII examinations and results obtained after the nasal intubation, the intubation was done in the chosen nostril in group B patients and in the nostril chosen by the anesthesiologist in the group A patient and the obstructions and timing with the manipulation required were checked by the anesthesiologist.

Results: The bleeding or epistaxis was found to be more among the subjects with group A -blinding compared to group B- non blinding. This difference was found to be statistically significant (p = 0.031). Also,the group A had to undergo a greater number of ET tube manipulation compared to the group B. This difference was found to be statistically significant (p = 0.027). The study also concluded that the required number of attempts in which the group A required greater number of attempts compared to the group B. This was also found to be statistically significant (p = 0.031).

Conclusion: The study concluded that the simple tests can be performed to identify a more patent nostril for the passage of nasotracheal tube. It also identifies the abnormalities of nasal passage such as bony spur, turbinate hypertrophy, enlarged adenoids and septal deviation hence reduces the chances of epistaxis. Thereby reduces tube manipulation required and number of attempts significantly.