Sarcouncil Journal of Medicine and Surgery

Abstract: Background: Nasal intubation is a commonly used method of intubation for oral & maxillofacial surgeries as it allows better surgical access & isolation for oral procedures. The classical & most common method to guide the endotracheal tube tip into the larynx is through the use of Magill forceps. Aim: to study: the use of cuff inflation technique to guide the tip of the endotracheal tube into the larynx instead of use of Magill forceps, in nasotracheal intubation. Patients & method: This prospective interventional case series was conducted on 62 patients, all were scheduled for elective maxillofacial surgery under general anesthesia, after preoxygenation and induction of anesthesia, Cormack & Lehane grading was assessed and the tube was introduced through the selected nostril until loss of resistance and the endotracheal tube tip reached the oropharynx, direct laryngoscopy was done and the tube cuff was inflated with 15ml of air to elevate tube tip from the posterior pharyngeal wall to be advanced gently into laryngeal inlet then it was deflated and advanced into the trachea and cuff was reinflated. Patients were classified into 3 grades according to difficulty of intubation (easy, requires external manipulation or tube rotation, requiring Magill forceps for intubation). Results: Nasotracheal intubation using cuff inflation technique was successful in 90.3% of the cases without using Magill forceps, 69.3% of cases being easy intubation, 21% of cases required external manipulation of cricoid or tube rotation & only 9.7% of cases required Magill forceps for intubation, the most important predictor for failure of cuff inflation technique was Cormack & Lehane Grading. 91.5% of Grade I patients had easy intubation while none of the grade II patients had easy intubation, 73.3% of grade II patients required manipulation or tube rotation for successful intubation while only 4.3% of grade I patients required manipulation of the tube for successful intubation. Conclusion: Cuff inflation technique is associated with a high rate of successful intubation in patients undergoing maxillofacial surgeries with Cormack & Lehane Grading I & II.