What Is Nasotracheal Intubation?

Intubation through the mouth is known as orotracheal intubation and through the nose is known as nasotracheal intubation.

Intubation is a bedside procedure in which a tube is inserted either into your nose or mouth to help you breathe better. It is a life-saving procedure done in emergency situations. 

Intubation through the mouth is known as orotracheal intubation and through the nose is known as nasotracheal intubation.

When you are unconscious, your breathing is affected. Your oxygen levels may fall, which can be dangerous. At such times, external breathing support is provided with the help of a machine known as a ventilator. The ventilator acts as breathing support by enabling you to breathe through intubation.

Nasotracheal intubation is used in various conditions such as:

• Surgeries of the neck and head
  • Oral surgeries: Surgeries involving the teeth, gums, and jaw.
  • Maxillofacial surgery: Reconstructive surgery of the face
  • Tonsillectomy: Removal of tonsils
• Oral route of intubation is not possible due to lockjaw (trismus)
• Severe cervical spine disease

Doctors may not plan nasotracheal intubation on you if you have

• A previous history of old or new skull fractures
• Bleeding disorders 
• Coagulopathy (clotting disorders)
• Apnea (a condition in which breathing stops due to obstruction in the upper respiratory system)
• Large nasal polyps (fleshy growths in the nose)
• Suspected nasal foreign bodies
• Recent nasal surgery
• Infection in your upper neck
• History of frequent episodes of epistaxis
• Prosthetic (artificial) heart valves

• Nasotracheal intubation is generally performed by an anesthetist.
• You will be given general anesthesia, which makes you numb and sleeps throughout the procedure. If you are unfit for anesthesia, you will be given sedatives to make you sleep.
• The anesthetist will first check if you are fit to be put on a ventilator. This is done by inflating a balloon-like structure known as a bag-mask into your nose through a lubricated tube (endotracheal tube).
• You might be given oxygen from the bag-mask to increase the levels of oxygen in your blood before the intubation.
• Certain medicines will be sprayed inside your nose to numb it and prevent bleeding.
• To prevent bleeding in your nose, a medicine like epinephrine or adrenaline will be sprayed inside your nose.
• The anesthetist will check if there is any obstruction in your nasal cavity by inserting a small tube-like structure, a nasal trumpet, in your nose.
• After checking the nasal cavity, the nasal trumpet will be removed, and an endotracheal tube will be inserted into one of your nostrils.
• A tube-like structure known as a laryngoscope will be inserted into the oral cavity to visualize your local cords (larynx).
• The laryngoscope will be used as a guide to correctly insert the endotracheal tube through the vocal cords into your windpipe. The windpipe is the part of your airway that is connected to your lung.
• Your doctor may still need to check if the tube has been placed correctly. To confirm this, they will listen to your breathing with a stethoscope.
• The endotracheal tube will then be connected to the ventilator.

The complications that can arise while performing the nasotracheal intubation include:

• Damage to nasal cavity: Your nose might bleed (epistaxis) when it is accidentally damaged during intubation.
• Damage to teeth: Teeth may get injured during laryngoscopy.
• Vocal cord damage: You may experience a sore throat or difficulty speaking due to vocal cord damage.
• Infection of trachea or lungs: You may find it hard to breathe due to infection of the trachea or lungs. 
• Pneumothorax: This complication involves the leaking of air in the space between the lungs and the chest wall.
• Obstruction of the endotracheal tube: Foreign bodies, polyps, or blood clots might partially or completely obstruct the endotracheal tube.
• Aspiration: Whatever you eat may get pulled into the lung.