Effectiveness of Computed Tomography-Guided Nasotracheal Intubation Procedure on Predicting Tube Advancement Difficulty and Preventing Epistaxis: A Prospective Case-control Study

Abstract

Abstract Purpose: To evaluate the effectiveness of Computed tomography-guided nasotracheal intubation in predicting tube advancement difficulty and preventing epistaxis.Material and Methods: Sixty maxillofacial surgery patients were included in the study. The space where the tube will be passed in the internal nasal valve region was measured horizontally and vertically by Computed Tomography. The same experienced anesthesiologist intubated all patients. The patients were divided into two groups, 'easy' (n=28) or 'difficult' (n=32), according to the effort required to advance the tube through the nasal passage.Results: The measured median distances were shorter in a difficult group than in the easy group (p<0.001). Epistaxis was significantly higher in the difficult group (p<0.001). Epistaxis was considerably higher in the difficult group (p<0.001).ROC analysis was performed, and cut-off values were determined to reveal the distance values at which difficulty may be experienced while advancing the tube. The cut-off values were 1.09 cm and 0.39 cm for the vertical and horizontal distances, respectively.Conclusion: It was concluded that taking into account the measurements obtained from the tomography scan was a convenient way to estimate the difficulty of advancing the tube and thus avoid nosebleeds encountered during nasal intubation.