Comparative efficacy and safety of the cuff inflation technique and the conventional Magill forceps method for nasotracheal intubation under direct laryngoscopy

Background: Nasotracheal intubation (NTI) is required in oral and maxillofacial surgery. The Magill forceps method guides the endotracheal tube but risks trauma and cuff damage. The cuff inflation technique redirects the tube by inflating the cuff in the oropharynx and may reduce complications. Aims and Objectives: To compare cuff inflation and Magill forceps during direct laryngoscopy-guided NTI in normal airways. Materials and Methods: A total of 70 American Society of Anesthesiologists I-II patients (18–60 years) scheduled for elective surgery under general anesthesia were randomized to Group C (cuff inflation, n=35) or Group M (Magill forceps, n=35). After induction, NTI was performed using the assigned technique. Outcomes included intubation time, attempts, manipulations, trauma, cuff injury, and hemodynamic changes. Data were analyzed using Chi-square, with P<0.05 significant. Results: Baseline characteristics were comparable between the groups. Mean intubation time was similar (28.25±4.2 vs. 26.94±3.8 s, P=0.182). First-attempt success was achieved in 31 and 33 patients in Groups C and M, respectively (P=0.391). Oropharyngeal trauma occurred in 17.1% of patients in Group M (P=0.021). Cuff damage was seen in one patient (2.9%) in Group M and none in Group C (P=0.311). Hemodynamic responses were comparable: Heart rate increased after intubation (96.8±7.5 vs. 98.2±7.9 bpm) and returned to baseline by 15 min (85.1±5.4 vs. 85.7±5.2 bpm), whereas mean arterial pressure rose immediately after intubation (101.4±8.1 vs. 102.1±7.7 mmHg) and stabilized within 15 min, with no significant intergroup differences (P>0.05). Conclusion: Cuff inflation is a safe alternative to Magill forceps, lowering trauma and cuff damage while maintaining similar efficiency and hemodynamic stability.