Nasal position of nasotracheal tubes: a retrospective analysis of intraoperatively generated three-dimensional X-rays during maxillofacial surgery.

Lili Plümer,Rainer Schmelzle,Philipp Pohlenz,Gerhard Schön,Henning Hanken,Jan Klatt

doi:10.1186/s40001-014-0055-7

Abstract

BackgroundThe aim of this retrospective investigation was to evaluate the position of the nasotracheal tube in the nose and to show its anatomical relationship with the maxillary sinus ostium.MethodsFifty data sets from patients who had undergone endonasal intubation were analyzed for tube positioning. There was a drop-out of eight data sets due to missing information concerning tube size and mode. Tube positioning was determined at the maxillary sinus ostium in the intraoperatively generated three-dimensional X-ray data sets. The type of tube, the tube size, and the presence of maxillary sinusitis were analyzed 30 minutes after intubation.ResultsThe tube was positioned in the middle nasal meatus in 35 (83.3%) patients and not in the middle nasal meatus in 7 (16.7%) patients. The difference in comparison with equal distribution was significant (P <0.001). The test value was 83.3; the 95% confidence interval of the test value was 68.6 to 93.0%. Maxillary sinusitis was diagnosed as a chance finding in 17% of patients (n =7).ConclusionsThe majority of nasal tubes are positioned in the middle nasal meatus. This result can be part of the answer to the question of the causal relationship between position of the breathing tube and the onset of maxillary sinusitis. The indications for prolonged nasotracheal intubation instead of orotracheal intubation or early tracheostomy should be considered carefully.

Highlights

The aim of this retrospective investigation was to evaluate the position of the nasotracheal tube in the nose and to show its anatomical relationship with the maxillary sinus ostium
A survey of colleagues from different surgical specialties showed that the prevailing majority opinion is to place the tube in the inferior nasal meatus, but this does not, for example, adequately answer the question of the causal relationship between the position of the breathing tube and the onset of maxillary sinusitis
The literature clearly shows that ventilator-associated pneumonia (VAP) and nosocomial sinusitis in Intensive care unit (ICU) entail considerable dangers for the health and even the life of the patient [5-8]

Summary

Introduction

The aim of this retrospective investigation was to evaluate the position of the nasotracheal tube in the nose and to show its anatomical relationship with the maxillary sinus ostium. Besides addressing the surgery-specific issues, it seemed obvious to consider the question of positioning the endonasal tube in patients who, for example, were already undergoing X-ray examination of all or part of the skull while under nasotracheal intubation anesthesia during dysgnathia surgery or jaw fracture treatment. This is important in patients undergoing operations lasting for several hours or facing long-term ventilation. A connection between these conditions and the tube seems reasonable; it is desirable to establish or rule out at an early stage whether the tube has directly or indirectly displaced the maxillary sinus ostium by moving the nasal soft tissues out of position

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Discussion

Conclusion