Asymptomatic intranasal abnormalities influencing the choice of nostril for nasotracheal intubation.

We have studied the prevalence of intranasal abnormalities that may influence the choice of nostril for intubation, using the fibreoptic laryngoscope, in 60 oral surgery patients presenting for nasotracheal intubation under general anaesthesia, who had no symptoms or signs of nasal obstruction. Videotape recordings were made during each nasendoscopy and later analysed by an anaesthetist and an otolaryngologist. A total of 68% of patients had intranasal abnormalities (10% bilateral and 58% unilateral) which resulted in one nostril being more patent than the other and therefore considered more suitable for intubation. The most common abnormality was deviated nasal septum which occurred in 57% of the study group; 22% were minor deviations, 13% were major deviations and 22% were impactions. Other abnormalities were simple spurs, unilateral polyp and hypertrophy of the inferior turbinate. In view of the relatively high incidence of intranasal pathology revealed on endoscopic examination, anaesthetists should consider using the fibreoptic laryngoscope to select the best nostril when performing nasotracheal intubation.