Nasotracheal intubation is a common technique used when surgeons operate in the oral cavity. Since it is a blind procedure, complications can occur due to trauma to the nasal septum medially and turbinates laterally. Epistaxis is one of the more common complications of nasal intubation [1,2]. In the majority of cases, it is mild to moderate, but at times it can be severe . Various methods have been tried to lessen the risk of epistaxis and include the use of various topical vasoconstrictors [4-6], dilation of the nasal cavity  and using smaller tubes that have been softened by warming .
Deviation of the nasal septum is found in approximately 80% of the general population , although in most cases this is asymptomatic. The following simple preoperative assessment will assist in identifying septal deviation, and intubation can then be performed through the wider nasal cavity thus reducing the risk of trauma:
(a) Examination of the caudal septum can be performed by gently elevating the tip of the nose and using a pen torch for illumination (Fig. 1);
(b) Steaming seen on the steel spatula held under the nostrils (Fig. 2).
This simple preoperative assessment will assist the anaesthetist in selecting the wider nasal passage for nasotracheal intubation and reduce trauma to the nasal cavity.
T. J. Woolford
Department of Otorhinolaryngology; Royal Hallamshire Hospital; Sheffield, UK
G. A. Francis
Department of Anaesthesia; Royal Hallamshire Hospital; Sheffield, UK
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