Anesth Pain Med.  2022 Jul;17(3):331-337. 10.17085/apm.21124.

Modified submental intubation techniques for maxillofacial surgery - A report of five cases -

• Jeon Yg
• Lee C
• Hong D
• Jin Y
• Lim HK

• KMID: 2535328
• DOI: http://doi.org/10.17085/apm.21124

Abstract

Background
Submental intubation has been the recommended airway management procedure for maxillofacial surgery since proposed by Altemir in 1986. We adopted various submental intubation modifications based on modified intubation protocols and report on the effectiveness and problems of each modified method. Case: Among a total of 13 submental intubation cases during the last five years, five representative methods are described. The proximal end of the endotracheal tube was protected by a nelaton catheter in case 1, by a suction connector in case 2, and by a dental needle cap in case 3. In case 4, a nasal speculum was used to expand a single route, and in case 5, a laparoscopic trocar was used to secure a single route. Conclusions: Use of a laparoscopic trocar might be the most effective way to obtain a single submental route. However, considering cost, use of a nasal speculum is also an effective suboptimal solution.

Keyword

Maxillofacial surgery; Nasal speculum; Submental intubation; Trocar

Figure

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  Fig. 1. Various submental intubation modifications and instruments. The proximal end of the endotracheal tube was protected by a nelaton catheter in Case 1 (A), and by a suction connector in Case 2 (B). To secure single route, black silk was passed through a submental route in Case 3 (C). The proximal end of the endotracheal tube was protected by a dental needle cap in Case 3 (D). To secure a single route a nasal speculumt was used in Case 4 (E), and a laparoscopic trocar was used in Case 5 (F).

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