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This study examines the incidence and site of tracheal tube impingement during nasotracheal fibreoptic intubation, and the efficacy of anticlockwise tube rotation to overcome the problem. Forty-three patients underwent fibreoptic-assisted nasotracheal intubation using a preformed nasal tube, and a second fibrescope was used to observe any obstruction to passage of the tracheal tube. Impingement occurred in 10 cases, with the most common site being the right arytenoid cartilage. Rotation resulted in successful intubation in all 10 cases, but proximal rotation did not always result in an equal degree of rotation at the tube tip. We conclude that the site of impingement for nasotracheal intubation with preformed nasal tubes is located at the posterior structures of the laryngeal inlet and that anticlockwise rotation is a simple and effective solution.

Original publication

DOI

10.1111/j.1365-2044.2006.04652.x

Type

Journal article

Journal

Anaesthesia

Publication Date

07/2006

Volume

61

Pages

646 - 650

Keywords

Adolescent, Adult, Anthropometry, Arytenoid Cartilage, Female, Fiber Optic Technology, Humans, Intubation, Intratracheal, Male, Middle Aged, Nasal Cavity, Rotation, Trachea, Treatment Failure