nasotraqueal

Nasotraqueal, or nasotracheal, refers to the airway route that passes from the nasal cavity to the trachea. In clinical use, it describes techniques and devices introduced through the nose to secure the airway, most commonly nasotracheal intubation. This approach is chosen when oral access is limited, when the surgical field favors a nasal route, or when prolonged airway control is needed during certain procedures.

Indications for nasotracheal intubation include dental, maxillofacial, and some head and neck surgeries, as well as situations where sparing the oral cavity facilitates surgical access or when an awake or differently oriented airway is required. It is generally performed by trained clinicians, such as anesthesiologists, using appropriate equipment and monitoring.

Contraindications include suspected basilar skull fracture or significant facial trauma, severe nasal obstruction or pathology, significant coagulopathy, and conditions increasing the risk of epistaxis or incorrect tube placement. Consideration of nasal patency and anatomy is essential before attempting the nasal route.

Equipment and preparation typically involve a nasotracheal tube, lubricant, and vasoconstrictor or topical decongestant to reduce mucosal bleeding, as well as suction, and visualization aids such as a laryngoscope or fiberoptic scope. Placement is confirmed with clinical assessment and capnography.

Complications can include epistaxis, sinusitis, nasal or dental trauma, tube malposition, airway trauma, aspiration, or intracranial placement in cases of skull base injury. The choice between nasotracheal and orotracheal approaches depends on clinical context, patient anatomy, and surgeon/anesthesiologist preference.