Bypassing nasotracheal intubation

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Is it possible to feed or administer oral medications to nasotracheally intubated patients?
—Mapara Qureshi, MD, Frederick, Md.

Nasotracheal intubation is generally reserved for specific situations, such as head and neck surgery, or when there is a need to access the oral cavity, such as with trauma. While the oropharynx is not obstructed by a nasotracheal tube, as it would be with standard intubation, the anatomic alterations distal to the visible oropharynx, i.e., in proximity to the larynx, trachea, and epiglottis, are still present. Hence the normal swallowing mechanism is disrupted, and feeding orally or administering oral medications is not recommended. Alternative modes of nutritional delivery are parenteral or enteral (for example, using a percutaneous endoscopic gastrostomy tube). Feeding a patient via nasogastric tube (using patent nare) in the context of nasotracheal intubation is not advisable given the risk of nasoseptal erosion.
—Christopher Ruser, MD (120-7)

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