Videoscopic Assisted Naso-tracheal Intubation Using Magill forceps Compared to Cuff Inflation Method

Background: Tracheal intubation remains a cornerstone of airway management. Nasotracheal intubation (NTI) offers specific advantages, including reduced need for neck extension, making it particularly useful in patients with cervical spine instability or limited mouth opening. To guide the endotracheal tube (ETT) into the trachea, Magill forceps or gradual cuff inflation may be used. While Magill forceps are effective, they carry risks of mucosal trauma and cuff damage and require adequate mouth opening.Objective: To compare the performance of video-assisted NTI using Magill forceps versus the cuff inflation technique in terms of intubation time, number of attempts, and complicationsMethods: This prospective, randomized study was conducted in the intensive care unit of a tertiary hospital. Fifty adult patients requiring NTI were allocated into two equal groups (n=25): one undergoing intubation with Magill forceps, the other using the cuff inflation technique. All procedures were performed under VL guidance.Results: Smooth intubation was achieved in 64% of the Magill group and 48% of the cuff inflation group. Absolute failure occurred in one Magill case and two inflation cases. Bleeding occurred equally in both groups (12%). A second intubation attempt was required in 24% of the Magill group and 32% of the cuff inflation group. Cuff damage occurred in three cases in the Magill group but was not observed in the inflation group. No statistically significant differences were found between groups in primary outcomes (p > 0.05). One patient experienced transient hypoxemia (SpO₂ <92%) and was managed with oral intubation. No serious complications were recorded.Conclusion: Both techniques are feasible and safe when combined. The cuff inflation method offers advantages in patients with limited mouth opening and reduces the risk of ETT cuff damage. However, tip misdirection during inflation can occur and may require additional manipulation.