title: Nasal position of nasotracheal tubes: a retrospective analysis of intraoperatively generated three-dimensional X-rays during maxillofacial surgery.
abstract: BACKGROUND
  The aim of this retrospective investigation was to evaluate the position of the nasotracheal tube in the nose and to show its anatomical relationship with the maxillary sinus ostium.
  
  
  METHODS
  Fifty data sets from patients who had undergone endonasal intubation were analyzed for tube positioning. There was a drop-out of eight data sets due to missing information concerning tube size and mode. Tube positioning was determined at the maxillary sinus ostium in the intraoperatively generated three-dimensional X-ray data sets. The type of tube, the tube size, and the presence of maxillary sinusitis were analyzed 30 minutes after intubation.
  
  
  RESULTS
  The tube was positioned in the middle nasal meatus in 35 (83.3%) patients and not in the middle nasal meatus in 7 (16.7%) patients. The difference in comparison with equal distribution was significant (P <0.001). The test value was 83.3; the 95% confidence interval of the test value was 68.6 to 93.0%. Maxillary sinusitis was diagnosed as a chance finding in 17% of patients (n =7).
  
  
  CONCLUSIONS
  The majority of nasal tubes are positioned in the middle nasal meatus. This result can be part of the answer to the question of the causal relationship between position of the breathing tube and the onset of maxillary sinusitis. The indications for prolonged nasotracheal intubation instead of orotracheal intubation or early tracheostomy should be considered carefully.
authors.affiliation: Center for Anesthesiology and Intensive Care Medicine, Department of Anaesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. l.pluemer@uke.de.
authors.forename: Lili
authors.initials: L
authors.lastname: Plümer
authors.affiliation: Center for Experimental Medicine, Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. g.schoen@uke.de.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schön
authors.affiliation: Own medical practice of Oral and Maxillofacial Surgery, Hamburg, Germany. klatt.jc@web.de.
authors.forename: Jan
authors.initials: J
authors.lastname: Klatt
authors.affiliation: Center for Clinical Neurosciences, Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. h.hanken@uke.de.
authors.forename: Henning
authors.initials: H
authors.lastname: Hanken
authors.affiliation: Own medical practice of Oral and Maxillofacial Surgery and of Plastic and Reconstructive Surgery, Hamburg, Germany. prof.r.schmelzle@gmail.com.
authors.forename: Rainer
authors.initials: R
authors.lastname: Schmelzle
authors.affiliation: Department of Oral and Maxillofacial Surgery and of Plastic and Reconstructive Surgery, Red Cross Hospital, Bremen, Germany. pohlenz@mkg-zentrum-pohlenz.de.
authors.forename: Philipp
authors.initials: P
authors.lastname: Pohlenz
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D007432:Intraoperative Period; D007442:Intubation, Intratracheal / Q000379:methods; D008297:Male; D015523:Maxillary Sinusitis / Q000601:surgery*; D008875:Middle Aged; D009296:Nasal Cavity / Q000473:pathology*; D012189:Retrospective Studies; D013515:Surgery, Oral / Q000379:methods; D014965:X-Rays