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Submental Intubation: An Alternative and Cost-Effective Technique for Complex Maxillofacial Surgeries

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Abstract

Introduction

Management of airway is a significant issue especially in cases of complex maxillofacial trauma like panfacial fractures or concomitant nasoethmoidal injuries, where the nasotracheal intubation is contraindicated or possess a significant problem. In these cases the only other alternative is tracheostomy. Submental intubation is an alternative to tracheostomy and it can be easily performed with little or lesser post-operative complications. This method involves lesser expenses as it does away with longer post-operative stay in the hospital as required by tracheostomy patients.

Technique

The patient is orally intubated with a reinforced armoured tube with a detachable plastic gas connector. An incision is made in the submental area of the patient and a tunnel is prepared from this region to the floor of the mouth through which the proximal end of the tube is diverted. Thus the occlusion of the patient can be checked intraoperatively. After completion of the surgery the proximal end in reintroduced onto the oral cavity and the patient is extubated orally.

Discussion

Originally proposed by Altemir in 1986, this method cannot be used in all cases as it is not without limitations. In spite of these, submental intubation can be a useful alternative to tracheostomy, especially in regions where cost cutting is a major factor in health infrastructure.

Conclusion

Maxillofacial surgeons addressing major facial trauma surgery may have this procedure in mind before opting for tracheostomy. It avoids a lot of complications associated with tracheostomy.

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References

  1. Amin M, Dill-Russel P, Manisali M, Lee R, Sinton I (2002) Facial fractures, submental tracheal intubation. Anaesthesia 57(12):1195–1199

    Article  CAS  PubMed  Google Scholar 

  2. Caubi AF, Vasconcelos BCE, Vasconcelos RJH, Morais HHAM, Rocha NS (2008) Submental intubation in oral maxillofacial surgery: review of literature and analysis of 13 cases. Med Oral Patol Oral Cir Bucal 13(3):E197–E200

    PubMed  Google Scholar 

  3. Gordon NC, Tolstunov L (1995) Submental approach to oroendotracheal intubation in patients with midfacial fractures. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 79(3):269–272

    Article  CAS  PubMed  Google Scholar 

  4. Green JD, Moore UJ (1996) A modification of submental intubation. Br J Anaesth 77(6):789–791

    CAS  PubMed  Google Scholar 

  5. Haddock AR, Barnard NA (1993) Maintaining the airway during treatment of severe facial injuries. Br Dent J 174(2):56–57

    Article  CAS  PubMed  Google Scholar 

  6. Hall D (1989) Nasotracheal intubation with facial fractures. JAMA 261:1198

    Google Scholar 

  7. Hernandez Altermir F (1986) The submental route for endotracheal intubation. A new technique. J Maxillofac Surg 14(1):64–65

    Google Scholar 

  8. Honig JF, Braun U (1993) Laterosubmental tracheal intubation. An alternative method to nasal nasal-oral intubation or tracheostomy in single step treatment of panfacial multiple fractures or osteotomies. Anaesthesist 42(4):256–258

    CAS  PubMed  Google Scholar 

  9. Kihara S, Komatsuzaki T, Brimacombe JR, Yaguchi Y, Taguchi N, Watanabe S (2003) A silicone-based wire-reinforced tracheal tube with a hemispherical bevel reduces nasal morbidity for nasotracheal intubation. Anesth Analg 97(5):1488–1491

    Article  PubMed  Google Scholar 

  10. MacInnis E, Baig M (1999) A modified submental approach for oroendotracheal intubation. Int J Oral Maxillofac Surg 28(5):344–346

    Article  CAS  PubMed  Google Scholar 

  11. Paetkau D, Strand M, Onc B (2000) Submental orotracheal intubation for maxillofacial surgery. Anaesthesiology 92:912–914

    Article  CAS  Google Scholar 

  12. Rungta N (2007) Technique of retromolar, submental intubation in facio-maxillary trauma patients. Ind J Trauma Anaesth Crit Care 8(1):573–575

    Google Scholar 

  13. Taicher S, Givol N, Peleg M, Ardekian L (1996) Changing indications for tracheostomy in maxillofacial trauma. J Oral Maxillofac Surg 54(3):292–295

    Article  CAS  PubMed  Google Scholar 

  14. Veenith T, Ganeshamoorthy S, Standley T, Carter J, Young P (2008) Intensive care unit tracheostomy: a snapshot of UK practice. Int Arch Med 1(1):21

    Article  PubMed  Google Scholar 

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Correspondence to Chiradip Kar.

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Kar, C., Mukherjee, S. Submental Intubation: An Alternative and Cost-Effective Technique for Complex Maxillofacial Surgeries. J. Maxillofac. Oral Surg. 9, 266–269 (2010). https://doi.org/10.1007/s12663-010-0084-x

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  • DOI: https://doi.org/10.1007/s12663-010-0084-x

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