If both nares are patent, the right naris may be preferable for intubation. The bevel when introduced will face the flat nasal septum, reducing the possibility of damage to the turbinates. The tube should also be directed more in and down instead of up and in. The opening in the nose is larger and less obstructed at the inferior aspect. To help direct the tube, the following technique may be utilized.
Lines represent the trachea Tilting and rotating the head with respect to the torso.
Rotation of the head aligns the axis of the tube with the soft tissue, rather than with the entrance of the larynx. Tilting the head toward the opposite side guides the tube toward the pyriform recess, lateral to the opening of the larynx. There are certain complications specific to nasotracheal intubation. The following table outlines the most common, some of which do not directly concern pre-hospital care providers. This particular method of airway management is most often performed on some of the most demanding patients.