The utilization of video laryngoscopy in nasotracheal intubation for oral and maxillofacial surgical procedures: a narrative review

Abstract

The video laryngoscope is a novel instrument for intubation that enables indirect visualization of the upper airway. It is recognized for its ability to enhance Cormack-Lehane grades in the management of difficult airways. Notably, video laryngoscopy is associated with equal or higher rates of intubation success within a shorter time frame than direct laryngoscopy. Video laryngoscopy facilitates faster and easier visualization of the glottis and reduces the need for Magill forceps, thereby shortening the intubation time. Despite the advanced glottic visualization afforded by video laryngoscopy, nasotracheal tube insertion and advancement occasionally fail. This is particularly evident during nasotracheal intubation, where oropharyngeal blood or secretions may obstruct the visual field on the monitor, thereby complicating video laryngoscopy. Moreover, the use of Magill forceps is markedly challenging or nearly unfeasible in this context, especially in pediatric cases. Furthermore, the substantial blade size of video laryngoscopes may restrict their applicability in individuals with limited oral apertures. This study aimed to review the literature on video laryngoscopy, discuss its clinical role in nasotracheal intubation, and address the challenges that anesthesiologists may encounter during the intubation process.

Keywords: Intubation, Nasotracheal; Oral Surgery; Ring, Adair, and Elwyn Tube; Video Laryngoscopes..

Fig. 1. Relevant anatomy during nasotracheal intubation (NTI). (a) Inferior nasal meatus Inferior turbinate, (b) nasopharynx, (c) oropharynx, (d) glottis.

Fig. 2. Nasotracheal tube (NTT) rotation by reducing the upward lifting of the blade while keeping the head in a neutral position. (a) The tip is positioned to the left of the glottis. (b) The NTT is rotated 90 degrees clockwise to orient the tip towards the glottis. (c, d) To facilitate a smooth entry of the NTT into the trachea, the upward lifting force on the blade is reduced while the patient's head is maintained in a neutral position.

Fig. 3. Reduction of the upward lifting of the blade. (a) The tip is posterior to the glottis. (b) By reducing the lifting force on the blade, the direction of the tip can be adjusted to align with the glottis.

Fig. 4. Cuff inflation. (a) The tip is slightly posterior to the glottis. (b) Inflating the cuff can shift the tip towards the glottis. (c) Once the tip passes through the glottis, the cuff is deflated. (d) The tube is further advanced into the trachea.