A nasotracheal tube introducer that minimizes damage on nasopharyngeal membranes

We usually choose nasal intubation in oral surgical procedures to provide sufficient oral cavity space for the surgeon. During nasal intubation procedure, the tip of the nasotracheal tube is advanced in the nasal cavity blindly. There are a number of reports of epistaxis, palatal perforation, perforation of cervical esophagus, obstruction by bleeding and dislocation of middle turbinate into the nasopharynx. We therefore developed a new nasotracheal tube with a balloon-tip introducer to decrease the complications and trauma to the nasopharyngeal membranes (Fig. 1). Five anesthetists participated to test this device using the Laerdal Airway Management Trainer® The process of nasotracheal intubation was as follows : Insertion of the inflatable balloon introducer into the nasotracheal tube was done. Let one fourth of the balloon protrude from the distal tip of the nasotracheal tube. After advancing the nasotracheal tube blindly through the nasopharynx until its tip is in the midpharyngeal cavity behind the fauces, the balloon is deflated and then, the balloon introducer is pulled out from the tube. The nasotracheal tube is further advanced and placed into the trachea using Magill forceps. We obtained satisfactory results using our new device on the Laerdal Model Trainer®. There was less resistance during insertion of the nasotracheal tube (Mallinckrodt®) when compared with that of the conventional tracheal tube. We believe that it is crucial to perform smooth insertion of the nasotracheal tube to minimize trauma on the nasopharyngeal membranes.