{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T15:21:41Z","timestamp":1787844101527,"version":"build-2784847793"},"reference-count":13,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T00:00:00Z","timestamp":1779148800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims:<\/jats:title>\n                    <jats:p>Nasotracheal intubation is commonly used in maxillofacial surgeries but often causes complications, with epistaxis being the most frequent. Selecting the more patent nostril and appropriate tube size can help reduce bleeding. Flexible nasal endoscopy (FNE) is traditionally used for this assessment but is invasive. Virtual nasal endoscopy (VNE), a non-invasive imaging technique, may offer an alternative. This randomized controlled study aimed to compare the incidence of epistaxis during nasotracheal intubation when guided by VNE vs FNE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and Methods:<\/jats:title>\n                    <jats:p>Sixty-four patients were enrolled. Preoperatively, VNE using OsiriX Lite software identified the more patent nostril and endotracheal tube (ETT) size. On surgery day, FNE was performed to assess the same. Patients were randomized into Group V (virtual) or Group E (endoscopy), with nostril side and Ring-Adair-Elwyn (RAE) tube size chosen accordingly. Incidence and severity of epistaxis during laryngoscopy and before throat packing, ease and time of insertion, manipulations, and number of attempts were recorded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The incidence and severity of epistaxis were significantly less in group V than group E at laryngoscopy (18.8% vs 59.4%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001) and during throat packing (31.2% vs 84.4%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001). The time taken for ETT insertion, tube impingement, and manipulations was also significantly reduced in group V.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Our study showed that the incidence of epistaxis was significantly less in VNE than in FNE-guided intubation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/joacp.joacp_458_25","type":"journal-article","created":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T09:00:24Z","timestamp":1779181224000},"page":"386-391","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Comparing the incidence of epistaxis during nasotracheal intubation with Ring-Adair-Elwyn tubes using virtual versus flexible nasal endoscopy in patients undergoing elective oral and maxillofacial surgeries \u2013 A randomized clinical trial"],"prefix":"10.4103","volume":"42","author":[{"given":"Chanjeeviram Sugantha","family":"Priya","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology and Critical Care, JIPMER, Puducherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chitra Rajeswari","family":"Thangaswamy","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Critical Care, JIPMER, Puducherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lenin Babu","family":"Elakkumanan","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Critical Care, JIPMER, Puducherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Balasubramanian","family":"Krishnan","sequence":"additional","affiliation":[{"name":"Department of Dentistry and Radiology, JIPMER, Puducherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krishnan","family":"Nagarajan","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Critical Care, JIPMER, Puducherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,5,19]]},"reference":[{"key":"R1-20260626","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1046\/j.1365-2044.2003.03034.x","article-title":"Nasotracheal intubation for head and neck surgery","volume":"58","author":"Hall","year":"2003","journal-title":"Anaesthesia"},{"key":"R2-20260626","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1097\/00000542-200201000-00014","article-title":"Nasotracheal intubation: A randomized trial of two methods","volume":"96","author":"Elwood","year":"2002","journal-title":"Anesthesiology"},{"key":"R3-20260626","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1017\/S0265021502251133","article-title":"Simple preoperative assessment to reduce the risk of traumatic epistaxis during nasotracheal intubation","volume":"19","author":"Kayarkar","year":"2002","journal-title":"Eur J Anaesthesiol"},{"key":"R4-20260626","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s00540-016-2262-6","article-title":"Validity of rhinometry in measuring nasal patency for nasotracheal intubation","volume":"31","author":"Shohara","year":"2017","journal-title":"J Anesth"},{"key":"R5-20260626","doi-asserted-by":"crossref","first-page":"882","DOI":"10.1093\/bja\/83.6.882","article-title":"Asymptomatic intranasal abnormalities influencing the choice of nostril for nasotracheal intubation","volume":"83","author":"Smith","year":"1999","journal-title":"Br J Anaesth"},{"key":"R6-20260626","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1046\/j.1365-2044.2001.01717-3.x","article-title":"Identifying the more patent nostril before nasotracheal intubation","volume":"56","author":"Smith","year":"2001","journal-title":"Anaesthesia"},{"key":"R7-20260626","first-page":"29","article-title":"[Virtual endoscopy of the nasal cavity and the paranasal sinuses with computerized tomography","volume":"96","author":"Morra","year":"1998","journal-title":"Anatomical study]. Radiol Med"},{"key":"R8-20260626","doi-asserted-by":"crossref","first-page":"578","DOI":"10.1007\/s004050000284","article-title":"Virtual endoscopy of the nasal cavity in comparison with fiberoptic endoscopy","volume":"257","author":"Han","year":"2000","journal-title":"Eur Arch Otorhinolaryngol"},{"issue":"5","key":"R9-20260626","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1007\/s12630-014-0156-3","article-title":"A styletted tracheal tube with a posterior-facing bevel reduces epistaxis during nasal intubation: A randomized trial","volume":"61","author":"Sugiyama","year":"2014","journal-title":"Can J Anaesth"},{"key":"R10-20260626","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/j.curtheres.2018.09.002","article-title":"North Polar tube reduces the risk of epistaxis during nasotracheal intubation: A prospective, randomized clinical trial","volume":"90","author":"\u00d6zkan","year":"2019","journal-title":"Curr Ther Res Clin Exp"},{"key":"R11-20260626","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.jclinane.2015.12.016","article-title":"Inspection of the nasopharynx prior to fiberoptic-guided nasotracheal intubation reduces the risk epistaxis","volume":"32","author":"Kwon","year":"2016","journal-title":"J Clin Anesth"},{"key":"R12-20260626","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1097\/00005537-199701000-00008","article-title":"Virtual endoscopy of the paranasal sinuses using perspective volume rendered helical sinus computed tomography","volume":"107","author":"Gilani","year":"1997","journal-title":"Laryngoscope"},{"key":"R13-20260626","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1097\/01.rct.0000134198.12043.42","article-title":"Three-dimensional visualization of the nasal cavity and paranasal sinuses. Clinical results of a standardized approach using multislice helical computed tomography","volume":"28","author":"Bisdas","year":"2004","journal-title":"J Comput Assist Tomogr"}],"container-title":["Journal of Anaesthesiology Clinical Pharmacology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/joacp.joacp_458_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T15:05:28Z","timestamp":1787843128000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/joacp.joacp_458_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,19]]},"references-count":13,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/joacp.joacp_458_25","relation":{},"ISSN":["0970-9185","2231-2730"],"issn-type":[{"value":"0970-9185","type":"print"},{"value":"2231-2730","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,19]]},"assertion":[{"value":"2025-08-04","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-24","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}