The patient underwent nasotracheal intubation before the surgical repair of mandibular fracture. Nasotracheal intubation is indicated in patients undergong procedures inside the mouth. Compare with orally placed tracheal tubes, the maximum diameter is usually smaller and the tubes longer, leading to increased resistance.
The contraindications to the use of a nasal tube include:
- Fracture of the base of the skull
- Nasal fractures
- Nasal polyps
- Coagulopathy
A vasoconstrictor such as phenylephrine-lidocaine mixture may be applied to the nasal mucosa. Usually a size 7.0 mm tube is used for women and a size 8.0 mm for men. The right nostril is preferred because the bevel of most tracheal tubes when introduced through the right nostril faces the flat nasal septum, reducing the chance of damage to the turbinates. After passage through the nose into the pharynx, the tube is advanced through the laryngeal inlet under direct vision using a laryngoscope and Magill's forceps to direct the tip of the tube towards the laryngeal opening. In addition to the complications of oral tracheal itubation, nasal hemorrhage, submucosal tear and dislodgement of tonsils or adenoids may also occur. Infection of the frontal and maxillary sinuses and bacteremia can occur after long-term nasotracheal intubation.
Text source: Churchull's Pocketbooks Anaesthesia - Nathanson and Mahajan
