Internal jaw thrust for nasogastric tube insertion: a case r
Published in the Indian Journal of Anaesthesiologists, the authors present a report a new technique of insertion of NG tubes in intubated patients, the “internal jaw thrust.”

With the head in neutral or flexed position, it is done by gently opening the intubated patient's mouth and inserting the thumb of the left hand into the oral cavity to grasp and lift the ETT (endotracheal tube) along with the tongue, whereas the other fingers lift the mandible externally; the NG tube is then introduced into the nares with the other hand.

This manoeuver lifts the arytenoids and makes the cricopharyngeus (upper oesophageal sphincter) patent (arrowhead) and allows easy passage of the NG tube (arrow) into the oesophagus.

The mechanism of this particular method may be similar to lifting the ETT tube with a laryngoscope, so that the inferior constrictor that marks the anatomical beginning of the oesophagus is displaced anteriorly. However, the advantage as compared with laryngoscopy is that no instrumentation is required. The authors did not encounter any trauma while practising this method.

Digital assistance of NG tube insertion has been described, but the authors have used the index finger to guide the NG tube in the oral cavity, which may be difficult in patients with limited mouth opening. A well-planned study is required to confirm the utility of this technique.

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