Asymptomatic intranasal abnormalities influencing the choice of nostril for nasotracheal intubation

We have studied the prevalence of intranasal abnormalities that may influen ce the choice of nostril for intubation, using the fibreoptic laryngoscope, in 60 oral surgery patients presenting for nasotracheal intubation under g eneral anaesthesia, who had no symptoms or signs of nasal obstruction. Vide otape recordings were made during each nasendoscopy and later analysed by a n anaesthetist and an otolaryngologist A total of 68% of patients had intra nasal abnormalities (10% bilateral and 58% unilateral) which resulted in on e nostril being more patent than the other and therefore considered more su itable for intubation. The most common abnormality was deviated nasal septu m which occurred in 57% of the study group; 22% were minor deviations, 13% were major deviations and 22% were impactions. Other abnormalities were sim ple spurs, unilateral polyp and hypertrophy of the inferior turbinate. In v iew of the relatively high incidence of intranasal pathology revealed on en doscopic examination, anaesthetists should consider using the fibreoptic la ryngoscope to select the best nostril when performing nasotracheal intubati on.