Journal of Dental Anesthesia and Pain Medicine

The Korean Dental Society of Anesthsiology (대한치과마취과학회)
권호 표지
DOI QR코드

DOI QR Code

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

  • Ito, Kana (Department of Dental Anesthesiology, Tokyo Dental College) ;
  • Kamura, Ayaka (Department of Dental and Oral Surgery, Tokyo Metropolitan Tama Medical Center) ;
  • Koshika, Kyotaro (Department of Dental Anesthesiology, Tokyo Dental College) ;
  • Handa, Toshiyuki (Department of Dental Anesthesiology, Tokyo Dental College) ;
  • Matsuura, Nobuyuki (Department of Oral Medicine and Hospital Dentistry, Ichikawa General Hospital) ;
  • Ichinohe, Tatsuya (Department of Dental Anesthesiology, Tokyo Dental College)
  • Received : 2022.08.29
  • Accepted : 2022.10.17
  • Published : 2022.12.01
Download PDF
⟨ Previous Next ⟩

Abstract

Background: 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. Methods: 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. Results: 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). Conclusion: Using binomial logistic regression analysis, we observed statistically significant differences in AX-CX and ∠ABC between the success group and the failure group.

Keywords

Acknowledgement

The author acknowledges Prof. Tatsuya Ichinohe for his assistance in editing the manuscript, and appreciates Dr. Ayaka Kamura, Senior Assist. Prof. Kyotaro Koshika Senior Assist, Prof. Toshiyuki Handa and Prof. Nobuyuki Matsuura for their continuous support with this study.

References

  1. Miller RD, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Cohen NH, Young WL. Miller'S Anesthesia. 8th ed. Amsterdam, Elsevier. 2015, pp 1651-3.
  2. Badheka JP, Doshi PM, Vyas AM, Kacha NJ, Parmar VS. Comparison of upper lip bite test and ratio of height to thyromental distance with other airway assessment tests for predicting difficult endotracheal intubation. Indian J Crit Care Med 2016; 20: 3-8. https://doi.org/10.4103/0972-5229.173678
  3. Reddy PB, Punetha P, Chalam KS. Ultrasonography - A viable tool for airway assessment. Indian J Anaesth 2016; 11: 807-13. https://doi.org/10.4103/0019-5049.193660
  4. Connor CW, Segal S. The importance of subjective facial appearance on the ability of anesthesiologists to predict difficult intubation. Anesth Analg 2014; 118: 419-27. https://doi.org/10.1213/ANE.0000000000000012
  5. Mahmoodpoor A, Soleimanpour H, Golzari SE, Nejabatian A, Pourlak T, Amani M, et al. Determination of the diagnostic value of the modified mallampati score, upper lip bite test and facial angle in predicting difficult intubation: a prospective descriptive study. J Clin Anesth 2017; 37: 99-102. https://doi.org/10.1016/j.jclinane.2016.12.010
  6. Guay J, Kopp S. Ultrasonography of the airway to identify patients at risk for difficult tracheal intubation : are we there yet? J Clin Anesth 2018; 46: 112-5. https://doi.org/10.1016/j.jclinane.2018.01.011
  7. Luba K, Apfelbaum JL, Cutter TW. Airway management in the outpatient setting. Clin Plast Surg 2013; 40: 405-17. https://doi.org/10.1016/j.cps.2013.04.005
  8. Kohjitani A, Miyawaki T, Miyawaki S, Nakamura N, Iwase Y, Nishihara K, et al. Features of lateral cephalograms associated with difficult laryngoscopy in Japanese children undergoing oral and maxillofacial surgery. Paediatr Anaesth 2013; 23: 994-1001. https://doi.org/10.1111/pan.12178
  9. Chhina AK, Jain R, Gautam PL, Garg J, Singh N, Grewal A. Formulation of a multivariate predictive model for difficult intubation : a double blinded prospective study. J Anaesthesiol Clin Pharmacol 2018; 34: 62-7. https://doi.org/10.4103/joacp.JOACP_230_16
  10. Chaconas SJ, Fragiscos FD. Orthognathic diagnosis and treatment planning: a cephalometric approach. J Oral Rehabil 1991; 18: 531-45.
  11. Graber LW, Vanarsdall RL, Vig KW, Huang G. Orthodontics: current principles and techniques. 6th ed. Amsterdam: Elsevier; 2015.
  12. Dahy KG, Takahashi K, Saito K, Kakeno A, Kiso H, Isobe Y, et al. The relationship between cephalogram analysis and oxygen desaturation index during sleep in patients submitted for mandibular setback surgery. J Craniofac Surg 2018; 29: e375-80. https://doi.org/10.1097/SCS.0000000000004386
  13. Narayanan A, Faizal B. Correlation of lateral cephalogram flexible laryngoscopy with sleep study in obstructive sleep apnea. Int J Otolaryngol 2015; 3: 1-7. https://doi.org/10.1155/2015/127842
  14. Kim D, Kim K, Sun J, Lim H. Conversion of an oral to nasal intubation in difficult nasal anatomy patients: two case reports. BMC Anesthesiol 2021; 21: 72. https://doi.org/10.1186/s12871-021-01298-6
  15. Takasugi Y, Futagawa K, Konishi T, Morimoto D, Okuda T. Possible association between successful intubation via the right nostril and anatomical variations of the nasopharynx during nasotracheal intubation: a multiplanar imaging study. J Anesth 2016; 30: 987-93 https://doi.org/10.1007/s00540-016-2253-7
  16. Japanese Standards Association (JSA): JIS T 7221:2020 Anaesthetic and respiratory equipment tracheal tubes and connectors.
  17. Taharabaru S, Sato T, Nishiwaki K. Difficult airway management in a patient with Nicolaides-baraitser syndrome who had a small jaw and limited mouth opening. Anesth Prog 2021; 68: 47-9. https://doi.org/10.2344/anpr-67-04-05
  18. Cormack RS, Lehane J. Difficult tracheal intubation in obstetrics. Anaesthesia 1984; 39: 1105-11. https://doi.org/10.1111/j.1365-2044.1983.tb08932.x
  19. Hyun K, Sumitomo S. Preoperative evaluation of the difficulty of laryngeal deployment. J Jpn Dent Soc Anesthesiol 1993; 21: 784-92.
  20. Ji C, Ni Q, Chen W. Diagnostic accuracy (CT, X-ray, US) for predicting difficult intubation in adults : a meta-analysis. J Clin Anesth 2018; 45: 79-87. https://doi.org/10.1016/j.jclinane.2017.12.023
  21. Yoo H, Choi JM, Jo JY, Lee S, Jeong SM. Blind nasal intubation as an alternative to difficult intubation approaches. J Dent Anesth Pain Med 2015; 15: 181-4.  https://doi.org/10.17245/jdapm.2015.15.3.181