Abstract

Nasotracheal intubation is a commonly employed technique during oral and maxillofacial surgeries under general anesthesia. Selecting the nostril with better patency may help minimize complications such as epistaxis. This study aimed to evaluate whether choosing the more patent nostril for nasotracheal intubation reduces the frequency and severity of epistaxis. A retrospective analysis was conducted at the Faculty of Dentistry, Akdeniz University, involving 171 patients who underwent maxillofacial procedures under general anesthesia. Participants were grouped according to the side of intubation: right nostril (Group R, n=92) and left nostril (Group L, n=79). All intubations were carried out by two experienced anesthesiologists using direct laryngoscopy. The intubation duration (from mouth opening to circuit connection) and the presence and severity of epistaxis were documented. Epistaxis was graded as none, mild (blood staining on the tube), or severe (visible blood pooling in the pharynx). Epistaxis occurred in 44.4% of all patients. Group L exhibited a significantly higher incidence and severity of epistaxis compared to Group R. Additionally, the mean intubation time was notably longer in Group L. The findings suggest that nasotracheal intubation via the right nostril may be associated with a reduced risk and severity of epistaxis, as well as shorter intubation times. These results highlight the potential benefits of right nostril selection in routine clinical practice when both nasal passages are deemed unobstructed.

Key words: Direct laryngoscopy, epistaxis, maxillofacial surgery, nasotracheal intubation, nostril