We read with interest the recent article by Sanuki et al. [1]. Their results suggest that the Parker Flex-TipTM tube (Parker tube; Parker Medical, Highlands Ranch, CO, USA) appears to be beneficial for nasotracheal intubation due to a lower incidence of nasal mucosal trauma and postoperative nasal pain compared with a conventional tube. However, several design aspects of this article should be clarified. The authors did not clearly describe whether all tubes were oriented in a standard manner with the concavity of the tube facing infero-posteriorly on insertion. It is generally believed that epithelial stripping by the tube's tip and bevel, especially over the middle turbinate or nasal septum, is a common cause of epistaxis during nasotracheal intubation [2]. When a conventional tube with a left-sided bevel and a right tip orientation is inserted into the nasal passage, the turbinates are more at risk of damage in the right nostril whilst the septum is more at risk in the left nostril. When the Parker tube, with a posterior bevel and an anterior tip, is passed through the nasal cavity in a standard manner, its tip and bevel do not face or contend with the turbinates and septum in either nostril. Also, the soft and flexible tip of the Parker tube may centripetally collapse on impact. This may result in a larger surface area in contact with, and a lower overall pressure being exerted on, the nasal tissues, thus decreasing the nasal tissue dissection caused by the tube's tip and bevel. Epistaxis was assessed immediately after the tube's tip had passed into the pharynx. This might have led to an underestimation of the incidence of severe epistaxis because flow of blood from the damaged site into the pharynx is delayed by pressure exerted by a tube on the nasal passage. We feel that assessing the severity of epistaxis 5 min after nasotracheal intubation by a blinded investigator would obtain a more precise evaluation. Fifteen minutes after extubation, patients were asked to rate their nasal pain on a 100-mm visual analogue scale. At what stage did the independent anaesthetists explain the details of the visual analogue scale from 0–100 mm for each patient? It is unclear how the investigators would have avoided effects of residual anaesthesia on the assessment of early postoperative nasal pain. It would also have been useful to assess the differences between the two tubes in difficulty with nasal breathing, persistent nasal bleeding, and nasal pain on the first postoperative day. There is no available preformed nasal version of the Parker tube. During head and neck surgery, vertical protrusion of the Parker tube from the nostril may make surgical procedures more difficult. Compared with the preformed nasal tube, the Parker tube is more difficult to secure and lack of the distal curve does not allow the breathing system connection to be placed away from the surgical field without use of a special connector and may result in a high risk of the tube kinking leading to airway obstruction during surgery.