Blind Nasotracheal Intubation Research Articles

Blind Nasotracheal Intubation in a Patient With Ankylosing Spondylitis and Severe Cervical Spine Deformities: A Case Report on Challenges and Approaches to Difficult Airway Management

Blind Nasotracheal Intubation in a Patient With Ankylosing Spondylitis and Severe Cervical Spine Deformities: A Case Report on Challenges and Approaches to Difficult Airway Management

Capnography-assisted airway management by awake blind nasal intubation in maxillofacial surgeries: An observational study

Background: Maxillofacial surgery patients frequently pose challenges to airway management due to anatomical and functional constraints. While fiber-optic-aided nasotracheal intubation is considered the gold standard, not all medical facilities have access to fiber-optic bronchoscopes, particularly in low-resource settings. In such situations, awake nasal tracheal intubation is often the safest approach for managing patients with known or suspected difficult airways. Aims and Objectives: (1) To assess the technique of capnography-assisted airway management by awake blind nasal intubation (ABNI) in maxillofacial surgeries. (2) To find out any complications encountered by the technique of capnography-assisted airway management by ABNI in maxillofacial surgeries. Materials and Methods: 40 patients undergoing various maxillofacial surgeries and in whom blind nasotracheal intubation was attempted were included in this study. The institutional ethical committee approved the study, and informed consent was obtained from all the patients. The number of attempts for ABNI, successful versus failed ABNI, and complications encountered were studied. SSPS 21.0 software was used for statistical analysis. Results: There were 23 (57.50%) males and 17 (42.50%) females. There was a male preponderance, with the M: F ratio being 1:0.73. The mean age of the patients was 40.97±8.92 years. In 36 (90%) of the patients, the intubation could be successfully done. In 19 (47.50%) patients, blind nasal intubation was successfully done in the first attempt; 2 attempts were required in 15 (37.50%) patients, and 3 attempts were required in 2 (5%) patients. Epistaxis (10%) and sore throats (7.5%) were the most common complications in the studied cases. Conclusion: Capnography-assisted ABNI is an effective technique for airway control in patients undergoing maxillofacial surgeries with an acceptable complication rate.

ANKYLOSIS OF THE TEMPOROMANDIBULAR JOINT

Introduction: Difficult intubation is a very dreaded situation in anesthesia and is frequently encountered in maxillofacial surgery15.7%(1)particularlyinpatientswithankylosisofthejoint temporomandibular (TMJ) the scarcity of equipment used in the event of difficult intubation (ID) such as that a nasofibroscopy represents a challenge and requires the use of other techniques (2). The interest of our study is to show the importance of capnography and ultrasound guidance during an ID blind nasotracheal. Comment: It concerns the management of the respiratory tract of a patient aged 41 years and 78 kg followed for epilepsy since childhood, substegretol 200mgx2/jet with congenital TMJ ankylosis. On the basis of preoperative clinical and radiological results, we have found the criteria for ID in particular the impossibility of opening the mouth and with the resources available, an intubation nasotracheal surgery under general anesthesia with spontaneous breathing was considered and a written informed consent for an emergency tracheotomy if required has been obtained from the patient. The procedure successively consisted of pre-oxygenation of the facial mask, xylocaine 0.05% a been sprayed into the right nostril, 0.05% xylocaine gargle, blockage of the laryngeal nerves superior by transcutaneous injections of lidocaine 1% and intra-tracheally, then we performed sedation with propofol 50mg. Blind nasotracheal intubation was successful in one uneventful attempt per No. 6.5 mm reinforced probe, the verification was made by visualizing the intra-tracheal probe at through ultrasound and confirmation by capnography. The anesthesia was completed by the administration of fentanyl 250 gamma, propofol 100 mg and rocuronium 40mg. Maintenance of anesthesia was performed by a mixture of isoflurane (1.5%) and oxygen and air (50%:50%). The patient was extubated after the surgical procedure and the operation was a success. Conclusion: The anesthesia of patients with TMJ ankylosis represents a situation where the difficulties tracheal intubation should be considered in principle, and where an anticipatory strategy should be developed. Due to the absence of anasofibroscopy, the anesthetic treatment must be carried out by a team experienced and trained in blind ID.

Usefulness of lateral cephalometric radiography for successful blind nasal intubation: a prospective study.

This study aimed to investigate the relationship between pharyngeal morphology and the success or failure of blind nasotracheal intubation using standard lateral cephalometric radiography and to analyze the measurement items affecting the difficulty of blind nasotracheal intubation. Assuming a line perpendicular to the Frankfort horizontal (FH) plane, the reference point (O) was selected 1 cm above the posterior-most end of the hard palate. A line passing through the reference point and parallel to the FH plane is defined as the X-axis, and a line passing through the reference point and perpendicular to the X-axis is defined as the Y-axis. The shortest length between the tip of the uvula and posterior pharyngeal wall (AW), shortest length between the base of the tongue and posterior pharyngeal wall (BW), and width of the glottis (CW) were measured. The midpoints of the lines representing each width are defined as points A, B, and C, and the X and Y coordinates of each point are obtained (AX, BX, CX, AY, BY, and CY). For each measurement, a t-test was performed to compare the tracheal intubation success and failure groups. A binomial logistic regression analysis was performed using clinically relevant items. The items significantly affecting the success rate of blind nasotracheal intubation included the difference in X coordinates at points A and C (Odds ratio, 0.714; P-value, 0.024) and the ∠ABC (Odds ratio, 1.178; P-value, 0.016). Using binomial logistic regression analysis, we observed statistically significant differences in AX-CX and ∠ABC between the success group and the failure group.

Windshield glass fragment mimicking a nasal fracture

A male patient with facial trauma by road traffic accident arrived in the emergency room and he was assisted by the Trauma and Neurosurgery team. After clinical evaluation a frontal sinus anterior wall fracture plus a nasal fracture were diagnosed. On the primary OMS examination was checked multiple facial lacerations and gross nasal dorsum deviation with pain, nasal airway obstruction and crepitus with clinical diagnosis of a nasal fracture. After radiologic exam a piece of windshield glass that was superimposed on the nasal bones simulating a nasal fracture was visualized. This paper presents clinical data and literature review of foreign body mimicking facial fractures.Descriptors: Road Traffic Accident; Facial Fractures; Windshield Glass.ReferênciasMazinis E, Lambrianidis T, Margelos J. Detection of a residual foreign body during root canal treatment. J Endod. 2005;31(9):691-93. Gray ST. Windshield safety glass foreign body masquerading as a root fragment. Dentomaxillofac Radiol. 1994;23(1):49-51.Goldstein E, Gottlieb MA. Foreign bodies in the nasal fossae of children. Oral Surg Oral Med Oral Pathol. 1973;36(3):446-47 .Madhere S, Barba CA, Painter RL, Morgan AS. Aspiration of shattered windshield glass after blind nasotracheal intubation in a motor vehicle crash. J Trauma. 1997;43:353-56.

Flexible nasotracheal intubation compared to blind nasotracheal intubation in the setting of simulated angioedema

BackgroundNasotracheal intubation is rarely performed in the emergency department (ED) but may be required in specific situations such as angioedema. Both blind and flexible nasal intubation (FNI) may be utilized; however, the preferred technique is unknown. MethodsWe performed a randomized, crossover manikin study using a convenience sample of emergency physicians and medical students from a local community teaching hospital. Using a simulated angioedema model, we sought to compare the time required to successfully perform nasotracheal intubation between traditional blind nasotracheal intubation and FNI. Participants performed nasal intubation with both FNI using the Ambu aScope Slim (Ambu, Ballarup, Denmark) and blind nasal intubation with a Parker Endotrol tube (Parker, CO) in random order. Number of attempts and time to successful intubation (TTI) were compared between treatment devices. Providers were stratified by experience level, defining junior providers as post-graduate level 2 and below (including medical students) and all others as senior providers. ResultsWe enrolled a convenience sample of 20 providers ranging from medical students to attendings. Overall, the TTI did not differ between blind and FNI intubation techniques (difference in seconds; 95% confidence interval) (21.4; −2.1 to 44.9; p = 0.07). This was consistent across provider types: senior providers (26.6; −17.7 to 71; p = 0.24) and junior providers (18.6; −8.3 to 46.5; p = 0.18). Number of attempts was similar between techniques (p = 0.55). ConclusionFNI and blind nasal intubation require similar time to intubation in this simulated model of angioedema.

Experience with Blind Nasotracheal Intubation for Temporomandibular Joint Ankylosis at Mayo Hospital, Lahore

Temporomandibular joint ankylosis presents a serious problem for airway management. Alternate or additional technique of airway control are required in this condition. Different options include blind nasotracheal intubation, fiberoptic intubation, retrograde intubation or tracheostomy. Moreover, the patient could be awake or asleep. The purpose of our study was to describe our experience with blind nasotracheal intubation after induction of general anesthesia with spontaneous ventilation in patients of temporomandibular ankylosis presenting for corrective surgery. This experience was gained on all the patients of temporomandibular joint ankylosis presenting to fasciomaxillary department at Mayo Hospital, Lahore over a period of 1 1/2 years. The surgery done was gap arthroplasty with genioplasty. Thirty six patients (male:24, female: 12) with age ranging between 3 years to 25 years with a mean of 12.56 years were studied. All the patients received premedication with atropine 10mg/kg body weight to dry up secretion. Patients were deeply anaesthetized with Halothane, Nitrous oxide with 50% oxygen. Thirty four patients were successfully intubated. Blind nasal intubation failed in 2 patients. The successful blind nasotracheal intubation for surgery for TMJ ankylosis needs adequately and deeply anaesthetized patients, relatively small well lubricated endotracheal tube passed through patent naris with atropine as premedication.

Warming Endotracheal Tube in Blind Nasotracheal Intubation throughout Maxillofacial Surgeries.

Blind nasotracheal intubation is an intubation method without observation of glottis that is used when the orotracheal intubation is difficult or impossible. One of the methods to minimize trauma to the nasal cavity is to soften the endotracheal tube through warming. Our aim in this study was to evaluate endotracheal intubation using endotracheal tubes softened by hot water at 50 °C and to compare the patients in terms of success rate and complications. 60 patients with ASA Class I and II scheduled to undergo elective jaw and mouth surgeries under general anesthesia were recruited. success rate for Blind nasotracheal intubation in the control group was 70% vs. 83.3% in the study group. Although the success rate in the study group was higher than the control group, this difference was not statistically significant. The most frequent position of nasotracheal intubation tube was tracheal followed by esophageal and anterior positions, respectively. In conclusion, our study showed that using an endotracheal tube softened by warm water could reduce the incidence and severity of epistaxis during blind nasotracheal intubation; however it could not facilitate blind nasotracheal intubation.

Cuff Inflation-Supplemented Laryngoscope-Guided Nasal Intubation

Softer endotracheal (ET) tubes are more difficult to navigate in the oropharynx than the stiffer polyvinyl chloride (PVC) tubes during nasotracheal intubation (NTI). Cuff inflation has been used to guide PVC tubes into the laryngeal inlet during blind NTI, but it has not been tested when performing NTI under direct laryngoscopic guidance. We assessed the role of cuff inflation in improving oropharyngeal navigation of 3 ET tubes of varying stiffness during direct laryngoscope-guided NTI. Simultaneously, we also assessed and compared the nasotracheal navigability and incidence of nasal injury with these ET tubes during cuff inflation-supplemented, laryngoscope-guided NTI. One hundred sixty-two adults were randomized to undergo NTI with either a conventional PVC (n = 54), wire reinforced (WR; n = 54) or a silicone-tipped WR (SWR; n = 54) ET tube. Ease of insertion of these tubes was assessed during passage from nose into oropharynx, from oropharynx into laryngeal inlet aided by cuff inflation if needed, and from laryngeal inlet into trachea. Nasal morbidity was assessed by a blinded observer. All ET tubes could be inserted into the trachea. Seventy-one of 162 ET tubes could be inserted from the oropharynx into the laryngeal inlet without cuff inflation. Eighty-six of the remaining 91 tubes that did not enter the laryngeal inlet without cuff inflation could be inserted when using the cuff inflation technique. Thus, a total of 157 ET tubes could be inserted into the laryngeal inlet with cuff inflation (95% confidence interval of difference of proportions between total number of tubes passed [157] and those without cuff inflation [71]: 53% [45%-61%]). The remaining 5 tubes had to be inserted with the help of Magill forceps. The incidence of epistaxis was lowest with the SWR tube (difference of proportions [95% confidence interval] SWR versus PVC 27% [8%-45%]; SWR versus WR 20% [1%-38%]; WR versus PVC 7% [-12% to 26%]). The cuff inflation technique consistently improved the oropharyngeal insertion of the 3 ET tubes of varying stiffness during direct laryngoscope-guided NTI. Supplemented with the cuff inflation technique, the SWR ET tube seems to be better than the PVC and WR ET tubes in terms of complete nasotracheal navigability and less perioperative nasal injury.

Anaesthetic Management of Temporomandibular Joint Ankylosis without Fibrotic Bronchoscope- A Review of 31 Cases

Introduction: Temporomandibular joint (TMJ) ankylosisis acondition associated with limited to zero mouth opening. In addition to facial asymmetry, malocclusion, anemia& malnutrition, airway obstruction may be present. All these changes make not only intubation but ventilation also difficult. Method: In this article we wantto report anaesthetic management of 31 patients having temporomandibular joint ankylosis by using blind nasal intubation technique. In all patients mouth opening is either zero or less than 5mm. Observation: In 87.09% patients we could intubate by blind nasotracheal intubation technique while 13.91% patients required tracheostomy. Conclusion: Blind nasal intubation, fiber optic guided nasal intubation, retrograde intubation &tracheostomy are the different techniques of securing airway in these patients. With proper preoperative preparation, induction with inhalationalagent & blind nasal technique for intubation we can manage patients of temporomandibular joint ankylosis successfully. Blind nasal intubation technique can be mastered by practice & is useful in managing difficultintubation cases particularly when fibrotic bronchoscope is not available

A modified tracheal tube with curvature-control function for blind nasotracheal intubation

A modified tracheal tube with curvature-control function for blind nasotracheal intubation

Efficacy of different doses of dexmedetomidine for conscious blind nasotracheal intubation

Objective To investigate the effect of different doses of dexmedetomidine for conscious blind nasotracheal intubation. Methods Fifty-one ASA?～? patients undergoing general anesthesia for elective surgery were randomly divided into 3 groups.The type of anesthesia for tracheal intubation (n = 17 each ): group ? received surface anesthesia only; group ? and ? received dexmedetomidine 0.5 or 1.0 礸/kg on top of surface anesthesia. All patients received surface anesthesia of nasal cavity, pharynx and larynx, trachea with 1% tetracaine. In group ? and group ? Dexmedetomidine 燞 ydrohloride 營 njection (batch number 10061434, approved number H20090248, produced by Jiangsu HengRui pharmaceutical Co., LTD) was diluted reach to 4 μ g/ml with the 0.9% sodium chloride solution. Then Dexmedetomidine 0.5 or 1.0 礸/kg Ⅳ 15 min. 1 min later conscious blind nasotracheal intubation was operated. MAP, HR and SpO2 were continuously monitored and recorded before anesthesia (T0), before trachea cannula (T1), when tracheal tube was inserted into nasal (T2) and advanced through vocal cords into trachea (T3). Responses like nausea,coughing and restlessness were also recorded. The patient 抯 awareness of the intubation was noted after operation. Results MAP and HR were significantly increased at T2 and T3, compared with them at T0 in group ?(P＜ 0.05). MAP was significantly decreased at T1, compared with it at T0 (P＜ 0.05); while MAP and HR were significantly increased at T3, compared with then at T0 in group Ⅱ (P＜ 0.05).MAP was significantly decreased at T1 、 T2and T3, compared with it at T0 (P＜ 0.05);and HR was significantly decreased at T1,compared with it at T0 (P＜ 0.05) in group ?. MAP and HR were significantly increased at T1、 T2 and T3 in group ?, compared with them in group ? and ? (P＜ 0.01). SpO2 was significantly decreased at T3in group ?,compared with it in group ? and ? (P＜ 0.01). MAP was significantly decreased at T1 、T2and T3 in group ?,compared with it in group ? (P＜ 0.05). HR was significantly decreased at T2and T3 in group ? ,compared with it in group ? (P＜ 0.05). The incidence of coughing, restlessness and awareness of the intubation were significantly lower in group ? than in group ? (P＜ 0.05). The incidence of nausea coughing, restlessness and awareness of the intubation were significantly lower in group ? than in group ? (P＜ 0.01). The incidence of nausea, coughing, restlessness and awareness of the intubation were significantly lower in group ? than in group ? (P＜ 0.05). Conclusion Dexmedetomidine 1.0 礸/kg given via Ⅳ slowly on top of surface anesthesia with 1% tetracaine can provide a good intubation condition with less intubation response for conscious blind nasotracheal intubation. It抯 safe and effective. Key words: Dexmedetomidine; Conscious blind nasotracheal intubation; Conscious sedation

Awake Blind Nasotracheal Intubation in Temporomandibular Joint Ankylosis Patients under Conscious Sedation Using Fentanyl and Midazolam.

Intubating a patient with temporomandibular joint ankylosis is always a challenge particularly when fibreoptic laryngoscope is not available. Awake blind nasotracheal intubation requires sufficient patient co operation and comfort. Presently available short-acting analgesics and amnesics are excellent choices for this exercise. This prospective randomized double blind study was designed to determine an appropriate dosage of fentanyl for awake blind nasotracheal intubation. We compared two different dosage of fentanyl. Eighty patients were randomly assigned to receive midazolam 0.05 mg/kg and fentanyl 2μg/kg in bolus (group I), or midazolam 0.05 mg/kg, fentanyl 3μg/kg in bolus (group II). Both dosage regimen ensured patient comfort and sedation. Patients in group II were more calm and sedated as compared to group I. Hemodynamics was also more stable in group II. For awake blind nasotracheal intubation, we therefore recommend midazolam 0.05mg/kg plus fentanyl 3μg/kg in bolus.

Difficult laryngoscopy caused by massive mandibular tori

Mandibular tori, defined as bony protuberances located along the lingual aspect of the mandible, are a possible cause of difficult intubation. We describe a case of mandibular tori that resulted in difficult intubation. A 62-year-old woman who had speech problems was diagnosed with mandibular tori, and was scheduled for surgical resection. On physical assessment, the patient had a class II Mallampati view and bilateral mandibular tori. Preoperative computed tomography images demonstrated that the bilateral mandibular tori arose from the lingual aspects of the second incisor to the first molar regions of the mandibular corpus, and occupied the floor of the mouth. In the operating room, anesthesia was induced with remifentanil and propofol. After complete paralysis was achieved, laryngoscopy was attempted several times with Macintosh blades. The massive tori prevented insertion of the tip of the blade into the oropharynx, and neither the epiglottis nor the arytenoids could be visualized, i.e., Cormack and Lehane grade IV. Blind nasotracheal intubation was successful and the surgery proceeded uneventfully. The anesthesiologist should examine any space-occupying lesion of the oral floor and should be vigilant for speech problems in order to detect mandibular tori that might impede intubation.

BLIND NASOTRACHEAL INTUBATION

Objective: Blind Nasotracheal Intubation (BNI) can be undertaken aftermuscle relaxation with Inj. Succinylcholine or under deep inhalational anesthesia. The objective of study was todetermine the preferred one of these 2 techniques of BNI. Design: Prospective, randomized study. Place andDuration of Study: PNS SHIFA, Karachi and AFID, Rawalpindi from May 2002 to April 2005. Subjects and Methods:Sixty patients between 10 - 40 years of age presenting for elective surgery in whom BNI was required due to limitedor no mouth opening were enrolled through convenient sampling. Patients were randomly divided into two groups:WMR (n=30) or NMR (n=30) to undergo BNI after relaxation with Succinylcholine or under inhalational anesthesia with2% Halothane, respectively. A red rubber nasal endotracheal tube (cuffed and un cuffed in adults and childrenrespectively) was used. Results: The frequency of successful BNI in WMR group was 100% and significantly higher(P=0.03) than in the NMR group (86%). Time to succeed was significantly less in the WMR group 2±0.9 minutes versus3.4±2.0 in the NMR group. There was no statistically significant difference of occurrence of adverse events in the twogroups. Conclusion: BNI with Succinylcholine produced a higher success rate. This technique can decrease failureto intubate, we speculate that it may, therefore, increase patient safety.

Prehospital airway management: A prospective evaluation of anaesthesia trained emergency physicians

To determine the characteristics of prehospital tracheal intubation and the incidence of difficult-to-manage airways in out-of-hospital patients managed by emergency medicine physicians with anaesthesia training. In a prospective study, conducted over a 4-year period, we evaluated all airway interventions performed by anaesthesia-trained emergency physicians. One thousand, one hundred and six out of 16,559 patients (6.8%) required tracheal intubation. Orotracheal intubation was attempted in 982, laryngoscopic aided nasotracheal intubation in 64 and blind nasotracheal intubation in 90 of the cases. Two techniques were used in 30 patients. Failure rates were 2.4, 8.1 and 25.6%, respectively. A Combitube or LMA was used in 2.0%. In one case of failed Combitube insertion successful needle cricothyrotomy was performed. In patients undergoing direct laryngoscopy, Cormack-Lehane laryngeal grade views I-IV were seen in 52.0, 28.8, 12.6 and 6.6% of cases, respectively. A difficult to manage airway (DMA) was reported in 14.8%, multiple intubation attempts in 4.3% and failed intubation in 2.0% of all cases. Grouping patients based on clinical presentation revealed a significantly higher incidence of DMA in trauma patients (18.6%) and during cardiopulmonary resuscitation (16.7%) than in the remaining patient group (9.8%). Intubation failed significantly more often in trauma (3.9%) than in the remaining patient group (1.1%). When compared to studies on laryngoscopy performed in the operating room, this study demonstrated a higher incidence of difficult and failed laryngoscopy, DAM, and high laryngeal grade views when patients were managed in a prehospital setting by anaesthesia trained physicians.

Use of a gum elastic bougie to facilitate blind nasotracheal intubation in children: a series of three cases

Management of a difficult paediatric airway is challenging, and the unavailability of a paediatric fibreoptic bronchoscope, a common limitation in developing countries, adds to these difficulties. Children with bilateral temporomandibular joint ankylosis have limited mouth opening and therefore direct laryngoscopy and intubation is not usually possible. In the absence of sophisticated fibreoptic equipment, blind nasal intubation remains the only non-surgical option for control of the airway. Blind nasal intubation in paediatric anaesthesia is difficult. We describe a novel method of blind nasal intubation in paediatric patients using a gum elastic bougie. We have used this method successfully in three patients in whom tracheal intubation using a conventional blind nasal approach was unsuccessful. In view of its reliability and the absence of any soft tissue injury, we propose the use of this novel technique as an alternative to conventional blind nasal intubation, when more sophisticated fibreoptic equipment is not available.

Facilitated blind nasotracheal intubation in paralysed patients with temporomandibular joint ankylosis.

To assess the efficacy of blind nasal intubation technique, in cases of ankylosis of temporomandibular joint (TMJ) without the facility of fiber optic bronchoscope. Analytical study. Maxillofacial Surgery Department, Armed Forces Institute of Dentistry, Rawalpindi, Pakistan, from August 2002 to October 2003. A total of 35 patients of ankylosis of TMJ were included in the study. Blind nasotracheal intubation technique was attempted after induction of anaesthesia and paralyzing the patients. Where blind nasotracheal intubation technique was not successful, one nasotracheal tube was passed into the esophagus and retained. Nasotracheal intubation was attempted through contralateral nares by second tube. Out of 35 patients male to female ratio was 1:1.2. The age of the patients ranged between 5 to 35 years with a mean age of 14.5 years. Blind nasotracheal intubation technique was successful in 23 cases (65.7%), whereas in 12 patients intubation was not successful. The 12 cases of failed blind nasotracheal intubation technique were successfully intubated nasotracheally by prior placement of nasotracheal tube into the esophagus through contralateral nares, which facilitated re-intubation (34.3%). In the selected patients blind nasotracheal intubation was facilitated by prior placement of the endotracheal tube into esophagus. This technique may be helpful in reducing the psychological trauma and complications of tracheostomy in such patients. However, to-date, fiber optic intubation remains the safest and widely accepted intubation technique in such patients.

Blind Nasotracheal Intubation in Penetrating Neck Trauma: A Good Idea . . . or Not?

Some experts have eschewed the use of blind nasotracheal intubation (BNTI) in patients with penetrating neck trauma, as BNTI might be less successful

Blind nasotracheal intubation for patients with penetrating neck trauma.

Early airway management is advocated for patients with penetrating neck trauma who have any signs of airway compromise. This study examined the clinical course of patients with penetrating neck trauma who received prehospital blind nasotracheal intubation, including successful intubation rates, and outcomes. A retrospective review of patients admitted to the emergency department for penetrating neck trauma was conducted from January 1, 1993 to July 1, 2001 at the Denver Health Medical Center. Patients were identified from the trauma registry, and data were collected using standardized inclusion and exclusion criteria. The study identified 240 patients with penetrating neck trauma. Overall mortality was 8.3%. Among the 240 patients, 89 (37%) required airway management, and 40 (17%) underwent prehospital management with blind nasotracheal intubation. The success rate for prehospital intubation using the blind nasotracheal method was 90%. The mean number of attempts was 1.16 (range, 1-4), and the mortality in this group was 5%. The patients managed with blind nasotracheal intubation did not experience complications related to the choice of airway management. Despite prior warnings in the literature, the results of this study suggest that blind nasotracheal intubation may well be a valuable tool for the management of patients with penetrating neck trauma.