Nostril dilatation is regularly practiced step before nasotracheal intubation . In our institute various mechanical , chemical and thermal techquines are used for dilataion which are associated with complications like trauma , bleeding , cuff leak and post operative pain upto some extent .Damaged flexometallic tube [ Armour tube – silicone type ] may be considered for dilatation purpose .100 adult male pateints underwent nostril dilatation with the help of flexo-metallic tube in our institute between November 2010 to November 2012 . All pateints were premedicatedwith inj. Glycopyrolate 0.2 mg IV and inj. Ondensteron 4 mg IV &Oxymetazoline nasal drops 30 minutes prior to procedure . General anaesthesia induced with Propofol&Scoline . Then sequential dilatation of nostril with lubricated ,damaged flexometallic tubes [ 28 , 30 , 32 ] bevel facing towards septum [ sterile tray ] is being done . Finally intubation with 8 number portex tube for all male patient is done . Total duration of dilatation is less than 40 seconds .

Following factors were noticed during the procedure :
1] No bleeding on dilatation tube
2] No bleeding in nasal cavity
3] No or minimal bleeding in oral cavity during laryngoscopy
4] Negligible chances of cuff leak of portex tube
5] At the time of extubation tube with minimal blood or mucus
6] Reduced or No complains from patient in post operative period – pain
Here the use of damaged flexometallic tube means tube with cuff leak , tube with eccentric cuff tube damaged at the shaft .At the time of dilatation tube cuff must be completely deflated and tube must be sterilised .By using this technique we are utilizing advantages of both endotracheal tubes and at same time avoiding few disadvantages .Rarely flexometallic tube does not pass through nostril at all – the only limitation found .

So I propose simple , economic , atruamatic and cuff leaked resistant method of nostril dilatation .
References :
1] A silicon - based wire reinforced tracheal tube with a hemispherical bevel reduces nasal morbidity for nasotracheal intubation , Kihara S , Komatsuzaki T, Brimacombe JR , Yaguchi Y Dept of Anaesthesia , Mito Saiseikai General hospital , Ibaraki , Japan
2] Pathways through the nose for nasal intubation : A comparison of three endotracheal tubes Ahmed – Nusrath A , Tong JL , Smith JE , Dept of Anaesthesia , University hospital Birmingham Birmingham B 15 2TH ; UK .
3] The influence of endotracheal tube tip design on nasal trauma during nasotrachealintubation ;magill – tip vs murphy – tip . Lee JH , Kim CH , Bahk JH , Park KS , Dept. of Anaesthesiology , Seoul National University Hospital & College of Medicine , Seoul , Korea

METHODS : Use lubricated damage flexometallic tube for dilatation and final intubation with Portex tube

RESULTS : Minimal nasal bleeding Rarely Endotracheal cuff leak Good intubation condition

CONCLUSIONS : Safe , Economic and Atraumatic method of Nostril dilatation for Nasal Intubation