“Two-hand-manoeuver” during nasotracheal intubation - SJA
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Nasotracheal intubation is the mainstay of airway management in oral and facial surgeries. Normally, nasotracheal intubation can be done with no or little difficulties, but sometimes, there may be some difficulty in passing tracheal tube through the nasal passage or passing beyond the epiglottis into the trachea.

After passing through the nasal cavity, tracheal tube may impinge on laryngeal structures. Induction of general anaesthesia may approximate the soft palate; tongue and epiglottis to the posterior pharyngeal wall and tracheal tube mostly impinge on epiglottis, right arytenoid, or interarytenoid. During flexible fibreoptic intubation when tracheal tube impinge on this structure, it was shown that a 90° counterclockwise rotation of tube usually helps in the smooth advancement of the tracheal tube into the trachea...

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