USG for assessing nostril patency for successful nasotracheal intubation

Teena Bansal, Jatin Lal

Department of Anaesthesiology & Critical Care
Pt. B.D. Sharma University of Health Sciences, Rohtak-124001 (Haryana), India.

Correspondence: Dr. Teena Bansal, 19/6 J, Medical Campus PGIMS, Rohtak-124001 (Haryana), India; E-mail: aggarwalteenu@rediffmail.com; Mobile: +91-9034239374

Citation: Bansal T, Lal J. USG for assessing nostril patency for successful nasotracheal intubation. Anaesth. pain intensive care 2020;24(4):470-471.
DOI: 10.35975/apic.v24i4.1324


A 45-year male was scheduled for reduction of fracture mandible. Mouth opening was 1 cm. So fibreoptic nasotracheal intubation was planned. Xylometazoline drops were instilled in the nostrils. Right nostril was more patent as compared to the left one. So a split nasopharyngeal airway size 7 mm was tried to be introduced through this nostril. But the attempt failed, so it was removed and blood was found on it reflecting trauma. Nasal drops were instilled in right nostril and then the same nasopharyngeal airway was introduced through the left nostril. Its insertion was very smooth and nasotracheal intubation was done successfully. Postoperatively ultrasound of nasal cavity was carried out and left nostril was found to be more patent contrary to preoperative examination.
Nasotracheal intubation is routinely performed procedure for maxillofacial surgeries. Patency of nostril is an important factor for successful intubation in addition to prevent intubation related trauma. Several tests have been introduced to assess the suitable nostril for nasotracheal intubation. Two simple tests are occlusion test and spatula test. But both these tests have a diagnostic failure rate of approximately 45% when an abnormal nostril was present. Rhinomanometry evaluates the patency of nostrils but it is not simple and requires special equipment. So, this method is not commonly used in clinical practice.1,2
Hence, we should not rely on occlusion test for determining nasal patency. Ultrasound of nasal cavity is suggested to confirm patency of nostril for nasotracheal intubation to increase success and prevent complications.

References
  1. Smith JE, Reid AP. Identifying the more patent nostril before nasotracheal intubation. Anaesthesia. 2001;56:258-262. [PubMed] DOI: 1046/j.1365-2044.2001.01717-3.x
  2. Shohara K, Goto T, Kuwahara G, Isakari Y, Moriya T, Yamamuro T. Validity of rhinometry in measuring nasal patency for nasotracheal intubation. J Anesth. 2017;31:1-4. [PubMed] DOI: 1007/s00540-016-2262-6