Computed Tomography-Guided Nasotracheal Intubation Procedure

Study Overview
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Brief Summary
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Background: Nasotracheal intubation can lead to severe complications like epistaxis with excessive bleeding. The advancement difficulty of the tube faced during nasal intubation is one of the fundamental causes of this condition. The present study aimed to evaluate the effectiveness of Computed tomography-guided nasotracheal intubation in predicting tube advancement difficulty and preventing epistaxis. Material and Methods: 60 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 (distance between inferior concha and septum) and vertically (distance between inferior concha and hard palate) by Computed Tomography. 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. 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 vertically and horizontally distances, respectively.

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

Conditions
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Computed Tomography-guided Nasotracheal Intubation, The Space Where the Tube Will be Passed in the Internal Nasal Valve Region

Intervention / Treatment
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* Procedure: computed tomography-guided nasotracheal intubation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Aged 18 to 65 who underwent bimaxillary orthognathic surgery defined as ASA (American Society of Anesthesiology) I or II Exclusion Criteria: The lack of preoperative CT scans airways evaluated and considered difficult by the anesthesiologist airways assessed and considered not appropriate for right angle endotracheal (RAE) tube with7.0 mm internal diameter history of sinusitis or head trauma anticoagulant therapy

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Procedure: computed tomography-guided nasotracheal intubation|Before intubation, the lower part of the nasal valve region, aka the narrowest area of the nasal passage, was measured by calculating the distance between the anterior border of the inferior concha and the septal cartilage|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Investigation of the relationship between internal nasal valve measurements and nasal advancement of the intubation tube | The measurements were carried out from the coronal sections at 0.25 intervals. Before intubation, the lower part of the nasal valve region, aka the narrowest area of the nasal passage, was measured by calculating the distance between the anterior border of the inferior concha and the septal cartilage. Additionally, using the same section of the CT image, the distance between the inferior concha and the hard palate was measured | during intubation procedure | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Computed Tomography, epistaxis, Maxillofacial Orthognathic Surgery, Intubation