{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T11:22:36Z","timestamp":1777893756935,"version":"3.51.4"},"reference-count":11,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Pediatric nasotracheal intubation may remain difficult at the stage of glottic alignment and laryngeal entry even after passage through the nasal cavity. We aimed to describe the distribution of adjunctive maneuvers required for glottic entry during pediatric nasotracheal intubation and to explore factors associated with their use. Methods: We conducted a prospective observational cohort study of 54 children undergoing dental surgery requiring nasotracheal intubation. Glottic-entry maneuvers were categorized as direct passage, cuff inflation assistance, or Magill forceps assistance. Baseline characteristics, perioperative variables, tube size selection, tube downsizing, and bleeding grade were compared among groups. Univariable and multivariable logistic regression analyses were performed for the primary outcome, defined as the need for any adjunctive maneuver. Results: Glottic entry was achieved by direct passage in 34 patients, required cuff inflation assistance in 15, and required Magill forceps assistance in 5. Baseline characteristics were broadly similar across groups, although sex distribution, body weight, and preoperative respiratory rate differed significantly. Anesthesia duration, surgery duration, bleeding grade, initial tube size, tube downsizing, and final tube size did not differ significantly among groups. In univariable logistic regression, female sex showed a borderline association with the need for any adjunctive maneuver, whereas age and initial tube size were not significant. In multivariable analysis, no stable independent predictor was identified. Conclusions: Most children achieved glottic entry by direct passage, whereas a minority required cuff inflation assistance or Magill forceps assistance. These prospective data provide a practical stepwise description of glottic-entry assistance during pediatric nasotracheal intubation.<\/jats:p>","DOI":"10.3390\/jcm15093455","type":"journal-article","created":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T06:50:01Z","timestamp":1777618201000},"page":"3455","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Adjunctive Maneuvers for Glottic Entry During Pediatric Nasotracheal Intubation: A Prospective Observational Cohort Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7817-5287","authenticated-orcid":false,"given":"Yiru","family":"Tong","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Shanghai Children\u2019s Hospital, School of Medicine, Shanghai Jiao Tong University, No. 355 Luding Road, Putuo District, Shanghai 200062, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jinghui","family":"Du","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Shanghai Children\u2019s Hospital, School of Medicine, Shanghai Jiao Tong University, No. 355 Luding Road, Putuo District, Shanghai 200062, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hengjiang","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Shanghai Children\u2019s Hospital, School of Medicine, Shanghai Jiao Tong University, No. 355 Luding Road, Putuo District, Shanghai 200062, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rong","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Shanghai Children\u2019s Hospital, School of Medicine, Shanghai Jiao Tong University, No. 355 Luding Road, Putuo District, Shanghai 200062, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Bozhou People\u2019s Hospital, Bozhou 236800, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8948-5996","authenticated-orcid":false,"given":"Henry","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"81","DOI":"10.17245\/jdapm.2024.24.2.81","article-title":"Nasotracheal intubation in pediatrics: A narrative review","volume":"24","author":"Kim","year":"2024","journal-title":"J. Dent. Anesth. Pain Med."},{"key":"ref_2","first-page":"183","article-title":"Nasotracheal intubation in children for outpatient dental surgery: Is fiberoptic bronchoscopy useful?","volume":"21","author":"Ozkan","year":"2018","journal-title":"Niger. J. Clin. Pract."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1093\/bja\/aeq205","article-title":"Xylometazoline pretreatment reduces nasotracheal intubation-related epistaxis in paediatric dental surgery","volume":"105","author":"Khattab","year":"2010","journal-title":"Br. J. Anaesth."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1097\/00000542-200702000-00010","article-title":"Telescoping tracheal tubes into catheters minimizes epistaxis during nasotracheal intubation in children","volume":"106","author":"Watt","year":"2007","journal-title":"Anesthesiology"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"72","DOI":"10.5603\/AIT.a2019.0002","article-title":"Complications associated with nasotracheal intubation and proposal of simple countermeasure","volume":"51","author":"Yamamoto","year":"2019","journal-title":"Anaesthesiol. Intensive Ther."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1111\/j.1460-9592.2010.03517.x","article-title":"A comparison of GlideScope\u00ae videolaryngoscopy and direct laryngoscopy for nasotracheal intubation in children","volume":"21","author":"Kim","year":"2011","journal-title":"Paediatr. Anaesth."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1213\/ANE.0b013e31827e4d19","article-title":"Cuff inflation-supplemented laryngoscope-guided nasal intubation: A comparison of three endotracheal tubes","volume":"116","author":"Kumar","year":"2013","journal-title":"Anesth. Analg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1002\/kjm2.12559","article-title":"Cuff inflation technique is better than Magill forceps technique to facilitate nasotracheal intubation guiding by GlideScope\u00ae video laryngoscope","volume":"38","author":"Lin","year":"2022","journal-title":"Kaohsiung J. Med. Sci."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1007\/BF03021066","article-title":"Blind nasotracheal intubation is facilitated by neutral head position and endotracheal tube cuff inflation in spontaneously breathing patients","volume":"50","author":"Chung","year":"2003","journal-title":"Can. J. Anesth."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"12585","DOI":"10.1038\/s41598-023-39793-0","article-title":"A new formula to predict the size and insertion depth of cuffed nasotracheal tube in children receiving dental surgery: A retrospective study","volume":"13","author":"Chou","year":"2023","journal-title":"Sci. Rep."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1007\/s00540-013-1778-2","article-title":"Incidence and predictors of difficult nasotracheal intubation with airway scope","volume":"28","author":"Ono","year":"2014","journal-title":"J. Anesth."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/9\/3455\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T07:01:40Z","timestamp":1777618900000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/9\/3455"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,1]]},"references-count":11,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["jcm15093455"],"URL":"https:\/\/doi.org\/10.3390\/jcm15093455","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,1]]}}}