Comparison of Nasal and Oropharyngeal Bleeding in Video Laryngoscopy Versus Direct Laryngoscopy for Nasotracheal Intubation in Maxillofacial Trauma: A Randomized Controlled Trial.

Abstract

Background: Nasotracheal intubation (NTI) is commonly used in maxillofacial trauma but carries a high risk of bleeding and airway complications, particularly with direct laryngoscopy (DL). Video laryngoscopy (VL) provides better glottic visualization and may reduce airway trauma. This study compares VL and DL for NTI in maxillofacial trauma patients, focusing on bleeding severity, intubation efficiency, and complications. Methods: This randomized controlled trial included 64 patients undergoing NTI for maxillofacial trauma, randomly assigned to VL or DL. The primary outcome was nasal and oropharyngeal bleeding severity, assessed using Fromme's scale. Secondary outcomes included first-pass success rate, intubation time, need for adjunctive maneuvers (Magill forceps and cervical spine extension), and intubation-related complications. All intubations were performed under general anesthesia following standardized airway preparation. Results: VL resulted in significantly lower nasal and oropharyngeal bleeding severity, with no bleeding (score 0) observed in 43.8% of the VL patients versus 12.5% of the DL group (p=0.005). VL also resulted in shorter intubation times (51.9 ± 7.9 s vs. 58.1 ± 8.7 s; p=0.003). The need for adjunctive maneuvers was significantly lower in the VL group (p < 0.001), and severe complications such as fractured teeth or deep lip injuries occurred more frequently in the DL group (p=0.02). The first-pass success rate was higher in the VL group (96.9%) than in the DL group (78.1%) though the difference was not statistically significant (p=0.058). Conclusion: VL demonstrated superior intubation efficiency and reduced bleeding severity compared with DL in maxillofacial trauma patients. Given its safety advantages and reduced need for adjuncts, VL appears to be a preferable technique for NTI in maxillofacial trauma though further multicenter studies are ensured. Trial Registration: ClinicalTrials.gov identifier: NCT06386757.