Using cone-beam CT for appropriate nostril selection in nasotracheal intubation

Objectives: Nasotracheal intubation is a standard blind procedure associated with various complications. The selection of the appropriate nostril is crucial to preventing most of these complications. The present study aimed to evaluate the predictive ability of cone-beam CT (CBCT) images to select the correct nostril for nasotracheal intubation. Methods: The study encompassed 60 patients who underwent maxillofacial surgery with nasotracheal intubation under general anaesthesia. While the anaesthetist made the appropriate nostril selection clinically according to a simple occlusion test and spatula test, the radiologist made the selection after analysing various CBCT findings such as the angle and direction of nasal septum deviation (NSD), minimum bone distance along the intubation path, and the presence of inferior turbinate hypertrophy. The appropriateness of these choices made blindly at different times was evaluated using descriptive statistics, chi-squared test, and independent samples t-test. Results: The study found that 83.3% of the suggested nostril intubations were successful. We also observed that intubation duration was longer when inferior turbinate hypertrophy was present (P =. 031). However, there was no statistical relationship between the presence of epistaxis and septal deviation (P =. 395). Nonetheless, in 64.3% of cases with epistaxis, the intubated nostril and the septum deviation direction were the same. Conclusions: Pre-operative evaluations using CBCT can aid anaesthetists for septum deviation and turbinate hypertrophy, as both can impact intubation success rates and duration.