Prolonged nasotracheal intubation and its association with inflammation of paranasal sinuses.

Sixteen critically ill patients whose tracheas were intubated through the nasal route were examined for paranasal sinusitis between the 2nd and 3rd day and again on the 8th day after intubation. Between the 2nd and 3rd days, 6 of the 16 patients developed either maxillary sinusitis alone (3 of them) or sphenoid sinusitis (in the other 3). By the 8th day, all patients had developed sinusitis involving at least one sinus. The most commonly affected sinuses were the maxillary (87%) and the sphenoid (87%) followed by the ethmoid (50%) and frontal (12.5%). On the day 8 after intubation, the nasotracheal tubes were removed and replaced by orotracheal tubes, or tracheostomies were performed. On day 8 after extubation, 10 of the 16 patients were reexamined. Computer tomographic (CT) scan at this time revealed persistent sinusitis in two. Long-term nasotracheal intubation is associated with sinusitis.