Innovative Techniques and Challenges in Securing Endotracheal Tubes Among Patients With Facial Hair: A Scoping Review

Background and Aims: Securing endotracheal tubes in patients with facial hair who refuse to shave remains a significant clinical challenge for anesthesiologists and intensive care specialists. This scoping review aims to identify and evaluate innovative endotracheal tube fixation techniques in these patients. Methods: A comprehensive search was conducted in PubMed, Scopus, Web of Science, Embase, Online Library, Cochrane Library, Google Scholar, and Gray Literature Sources, following PRISMA-ScR guidelines. The search focused on articles published between 1990 and April 2026. Eligible articles comprised case reports, case series, letters, editorials, reviews, and clinical trials related to endotracheal tube fixation methods in patients with facial hair. Studies without relevant fixation methods or without full text were excluded. Titles, abstracts, and full texts were independently screened by two senior anesthesiologists, and discrepancies were resolved by a third reviewer. A descriptive thematic analysis was conducted to identify patterns and systematically categorize fixation techniques. Results: From an initial pool of 47 studies, seven met the inclusion criteria: six case reports/letters and one randomized clinical trial. Three innovative endotracheal tube fixation categories were identified: facial coverings using Tegaderm, Dynaplast, or modified serum bottles; remote securement via straps or tapes positioned away from the face; and mustache-based stabilization involving ligation of the endotracheal tube to the patient's elongated mustache. Reported advantages included facial hair preservation, reduced jugular vein pressure, minimal surgical field disruption, wide materials accessibility, avoidance of adhesive-related reactions, and cost-effectiveness. However, identified limitations included lack of direct comparisons with conventional fixation techniques, limited generalizability due to anecdotal evidence bases, and insufficient evaluation in diverse surgical positions. Conclusion: Current evidence regarding standard methods for securing endotracheal tubes in patients with facial hair is limited, and long-term safety and efficacy are insufficiently evaluated. Future randomized controlled trials for comparing these innovative approaches with conventional methods are required.