Which is the most common complication associated with nasotracheal intubation?

• A. Epistaxis
• B. Bleeding
• C. Nasal trauma
• D. Pneumothorax

Answer: (B)

During nasotracheal intubation the tube passes through the nasal passage where the mucosa is thin and highly vascular. The most common complication is epistaxis, a nosebleed, because trauma to the nasal mucosa—especially near the anterior septum where Kiesselbach’s plexus resides—readily tears vessels and causes bleeding. This bleeding is often mild and can be managed with topical vasoconstrictors, gentle pressure, and suction; more significant cases may require packing or ENT help. While nasal trauma and, much less commonly, pneumothorax can occur, they happen far less frequently than epistaxis.