Effect of Nasotracheal Tube Bevel Orientation on Epistaxis, Intubation Difficulty, and Intraoperative Complications

Abstract

Background: Nasal bleeding is a common event during nasotracheal intubation. The present trial examined whether altering bevel orientation (upward, downward, right, or left) affects the likelihood of epistaxis, ease of intubation, and intraoperative outcomes. Methods: In this triple-blind randomized controlled trial, 200 candidates for elective oral and maxillofacial procedures were randomized into four groups based on bevel orientation. The principal endpoint was the frequency and severity of epistaxis. Secondary endpoints included intubation time, difficulty score, hemodynamic responses, and oxygen saturation. Data were evaluated using chi-square, ANOVA, and Kruskal–Wallis tests (p<0.05). Results: The incidence and grading of epistaxis, intubation time, and difficulty did not significantly differ between the four orientations. Hemodynamic and oxygenation parameters remained stable throughout. Lateral orientations showed a non-significant tendency toward less bleeding and smoother tube passage. Conclusion: Bevel direction did not significantly influence bleeding or difficulty of nasotracheal intubation, although subtle clinical advantages were observed. Larger trials are needed to clarify the potential benefits. Copyright © 2026 Tehran University of Medical Sciences.