Comparing the incidence of epistaxis during nasotracheal intubation with Ring-Adair-Elwyn tubes using virtual versus flexible nasal endoscopy in patients undergoing elective oral and maxillofacial surgeries – A randomized clinical trial

Abstract Background and Aims: Nasotracheal intubation is commonly used in maxillofacial surgeries but often causes complications, with epistaxis being the most frequent. Selecting the more patent nostril and appropriate tube size can help reduce bleeding. Flexible nasal endoscopy (FNE) is traditionally used for this assessment but is invasive. Virtual nasal endoscopy (VNE), a non-invasive imaging technique, may offer an alternative. This randomized controlled study aimed to compare the incidence of epistaxis during nasotracheal intubation when guided by VNE vs FNE. Material and Methods: Sixty-four patients were enrolled. Preoperatively, VNE using OsiriX Lite software identified the more patent nostril and endotracheal tube (ETT) size. On surgery day, FNE was performed to assess the same. Patients were randomized into Group V (virtual) or Group E (endoscopy), with nostril side and Ring-Adair-Elwyn (RAE) tube size chosen accordingly. Incidence and severity of epistaxis during laryngoscopy and before throat packing, ease and time of insertion, manipulations, and number of attempts were recorded Results: The incidence and severity of epistaxis were significantly less in group V than group E at laryngoscopy (18.8% vs 59.4%, P < 0.001) and during throat packing (31.2% vs 84.4%, P < 0.001). The time taken for ETT insertion, tube impingement, and manipulations was also significantly reduced in group V. Conclusion: Our study showed that the incidence of epistaxis was significantly less in VNE than in FNE-guided intubation.