Abstract
Introduction
Airway management for patients who suffered midfacial fractures is complicated. In maxillofacial injuries, a choice has often to be made between different ways of intubation when surgical access to both the nasal and oral cavities is necessary. Submental intubation technique is an alternative to nasoendotracheal intubation and tracheostomy in the management of patients with severe midfacial fractures. This procedure is simple to do and has a low morbidity.
Material
Submental intubation-paramedian technique has been used in 15 cases from May 2005–April 2007 in Hosmat Hospital, Bangalore. All patients had fractures disturbing the dental occlusion plus either an associated fracture of the skull base or a displaced nasal fracture.
Results
Average duration of procedure was 7 minutes. Average duration of tube in vitro after surgery was 20 hours. There were 2 postoperative complications of tube obstruction which were successfully managed.
Conclusion
Submental intubation demands certain technical skills but it is simple, rapid and may avoid tracheostomy in selected patients.
Keywords: Midfacial fractures, Submental intubation, Maxillofacial injuries
Full Text
The Full Text of this article is available as a PDF (152.2 KB).
References
- 1.Arrowsmith J.E., Robertshaw H.J., Boyd J.D. Nasotracheal intubation in the presence of frontobasal skull fracture. Can J Anaesth. 1998;45(1):71–75. doi: 10.1007/BF03011998. [DOI] [PubMed] [Google Scholar]
- 2.Meyer C., Valfrey J., Kjartansdottir T., Wilk A., Barrière P. Indication for and technical refinements of submental intubation in oral and maxillofacial surgery. J Craniomaxillofac Surg. 2003;31(6):383–388. doi: 10.1016/j.jcms.2003.07.005. [DOI] [PubMed] [Google Scholar]
- 3.Chandu A., Smith A.C., Gebert R. Submental intubation: an alternative to short-term tracheostomy. Anaesth Intensive Care. 2000;28(2):193–195. doi: 10.1177/0310057X0002800212. [DOI] [PubMed] [Google Scholar]
- 4.Paetkau D.J., Stranc M.F., Ong B.Y. Sub mental orotracheal intubation for maxillofacial surgery. Anesthesiology. 2000;92(3):912. doi: 10.1097/00000542-200003000-00063. [DOI] [PubMed] [Google Scholar]
- 5.Lanza D.C., Parnes S.M., Koltai P.J., Fortune J.B. Early complications of airway management in head-injured patients. Laryngoscope. 1990;100(9):958–961. doi: 10.1288/00005537-199009000-00009. [DOI] [PubMed] [Google Scholar]
- 6.MacInnis E., Baig M. A modified submental approach for oral endotracheal intubation. Int J Oral Maxillofac Surg. 1999;28(5):344–346. doi: 10.1034/j.1399-0020.1999.285280506.x. [DOI] [PubMed] [Google Scholar]
- 7.Goldenberg D., Golz A., Netzer A., Joachims H.Z. Tracheotomy changing indications and a review of 1130 cases. J Otolaryngol. 2002;31(4):211–215. doi: 10.2310/7070.2002.21091. [DOI] [PubMed] [Google Scholar]
- 8.Gordon N.C., Tolstunov L. Submental approach to oroendotracheal intubation in patients with midfacial fractures. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1995;79(3):269–272. doi: 10.1016/S1079-2104(05)80218-5. [DOI] [PubMed] [Google Scholar]
- 9.Hernandez Altemir F. The submental route for endotracheal intubation. A new technique. J Maxillofac Surg. 1986;14(1):64–65. doi: 10.1016/S0301-0503(86)80261-2. [DOI] [PubMed] [Google Scholar]
- 10.Marlow T.J., Goltra D.D., Schabel S.I. Intracranial placement of a nasotracheal tube after facial fracture: a rare complication. J Emerg Med. 1997;15(2):187–191. doi: 10.1016/S0736-4679(96)00356-3. [DOI] [PubMed] [Google Scholar]
- 11.Malhotra N., Bhardwaj N., Chari T. Submental endotracheal intubation: A useful alternative to tracheostomy. Indian J Anaesthiology. 2002;46(5):400–402. [Google Scholar]
- 12.Mak P.H., Ooi R.G. Submental intubtion in a patient with betathalassaemia major undergoing elective maxillary & mandibular osteotomies. Br J Anaesth. 2002;88(2):288–291. doi: 10.1093/bja/88.2.288. [DOI] [PubMed] [Google Scholar]
- 13.Rhee K.J., Muntz C.B., Donald P.J., Yamada J.M. Does nasotracheal intubation increase complications in patients with skull base fractures? Ann Emerg Med. 1993;22(7):1145–1147. doi: 10.1016/S0196-0644(05)80980-1. [DOI] [PubMed] [Google Scholar]
- 14.Mahmood S., Lello G.E. Oral Endotracheal intubation:Median submental(Retrogenial) approach. J Oral Maxillofac Surg. 2002;60(4):473–474. doi: 10.1053/joms.2002.31244. [DOI] [PubMed] [Google Scholar]
- 15.Taicher S., Givol N., Peleg M., Ardekian L. Changing indications for tracheostomy in maxillofacial trauma. J Oral Maxillofac Surg. 1996;54(3):292–295. doi: 10.1016/S0278-2391(96)90744-2. [DOI] [PubMed] [Google Scholar]
- 16.Smoot E.C., Jernigan J.R., Kinsley E., Rey R.M., Jr A survey of operative airway management practices for midface fractures. J Craniofac Surg. 1997;8(3):201–207. doi: 10.1097/00001665-199705000-00012. [DOI] [PubMed] [Google Scholar]
- 17.Nyarady Z., Sari F., Olasz L., Nyarady J. Modified submental intubation endotracheal intubation in concurrent orthognathic surgery. Mund Kiefer Gesichtschir. 2004;8(6):387–389. doi: 10.1007/s10006-004-0570-8. [DOI] [PubMed] [Google Scholar]
- 18.Nyarady Z., Sari F., Olasz L., Nyarady J. Submental endotracheal intubation in concurrent orthognathic surgery: A technical note. J Craniomaxillofac Surg. 2006;34(6):362–365. doi: 10.1016/j.jcms.2006.04.003. [DOI] [PubMed] [Google Scholar]