J Korean Assoc Oral Maxillofac Surg.  2016 Apr;42(2):99-104. 10.5125/jkaoms.2016.42.2.99.

Evaluation of safety and usefulness of submental intubation in panfacial trauma surgery

• Singaram M
• Ganesan I
• Kannan R
• Kumar R

• KMID: 2351732
• DOI: http://doi.org/10.5125/jkaoms.2016.42.2.99

Abstract

OBJECTIVES
Submental intubation has been advocated as an alternative to classical tracheostomy for certain indicated panfacial trauma surgeries. Surgeons should have various options for airway management in maxillofacial trauma patients. Most maxillofacial injuries involve occlusal derangements, which might require intraoperative occlusal corrections; hence, orotracheal intubation is not ideal. Maxillofacial surgeons generally prefer nasotracheal intubation; however, in cases with concomitant skull base fracture or nasal bone fracture, nasotracheal intubation might not be suitable; in these situations, tracheostomy is typically performed. However, the possible complications of tracheostomy are well known. Due to trauma situations and to avoid the complications of tracheostomy, submental intubation would be an ideal alternative procedure in selected maxillofacial trauma surgery patients. This study aimed to evaluate the safety and usefulness of a submental intubation technique for panfacial trauma surgery. Moreover, we intended to share our experience of submental intubation and to recommend this simple, safe procedure for certain panfacial trauma surgeries.
MATERIALS AND METHODS
In five panfacial trauma patients, we performed submental intubation for airway management; the mean time required for the procedure was only eight minutes.
RESULTS
We were able to execute this procedure safely in a short time without any intraoperative or postoperative complications.
CONCLUSION
Submental intubation is a safe and simple technique for airway management in indicated panfacial trauma surgery patients.

Keyword

Panfacial trauma; Intubation; Tracheostomy; Maxillofacial injuries

MeSH Terms

Airway Management
Humans
Intubation*
Maxillofacial Injuries
Nasal Bone
Postoperative Complications
Skull Base
Tracheostomy

Figure

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  Fig. 1 Submental skin incision.

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  Fig. 2 Traversing through mylohyoid muscle to intra-oral.

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  Fig. 3 Oro tracheal tube has taken out through submental tunnel.

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  Fig. 4 Endotracheal tube; connected to the circuit.

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  Fig. 5 Postoperative; skin scar.

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  Fig. 6 A, B, D-F. Three-dimensional reconstructed computed tomography (CT) of all patients. C. CT image shows fracture of bilateral parasymphysis (mandible; arrows).

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