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Pitak-Arnnop P, Tangmanee C, Subbalekha K, Sirintawat N, Urwannachotima N, Auychai P, Messer-Peti R, Meningaud JP, Neff A. Factors associated with complications of submental intubation in 339 patients with facial fractures: A German retrospective cohort study. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 124:101332. [PMID: 36400390 DOI: 10.1016/j.jormas.2022.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 10/27/2022] [Accepted: 11/14/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE For nearly four decades, submental intubation (SI) has been introduced and employed to avoid tracheostomy in facial trauma cases where nasal/oral intubation is infeasible or associated with possible risks. The purposes of this study were to estimate the frequency and to identify variables associated with complications of SI (CSI). METHODS The authors organised a retrospective cohort study and enrolled a group of patients with facial trauma and SI during a seven-year interval at two German level one trauma centres where SI has routinely been used in complex facial trauma cases. The predictor variables included demographic, medical, dental, fracture-related, operative, and postoperative parameters. The outcome variable was CSI. We used descriptive, bivariate, and multivariate analyses at the 0.05 significant level. RESULTS The sample included 339 patients (24.5% females, 9.4% had complications) with an average age of 58.2 ± 12.0 years (range, 17-89). Bivariate analyses revealed nine significant variables. However, forward stepwise multiple logistic regression modelling identified three variables statistically associated with CSI: smoking (OR, 691.8; 95% CI, 75.9 to 6303.9; P < 0.0001; number needed to harm [NNH], 6), moderate to high gingival inflammation (OR, 786.7; 95% CI, 66 to 9378.9; P = 0.002; NNH, 12), and postoperative use of chlorhexidine mouthwash (OR, 0.03; 95% CI, 0.001 to 0.77; P = 0.0003; number needed to treat [NNT], 2). CONCLUSIONS smokers and subjects with gingivitis were more likely to experience CSI. Postoperative chlorhexidine rinsing was the potentially modifiable, albeit low-OR, factor. These findings could help to draw an effective guideline against the CSI.
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Panchamia JK, Hill D, Sharaf B, Amundson AW. Submental approach to intubation for craniomaxillofacial surgery. Can J Anaesth 2021; 68:727-728. [PMID: 33475956 DOI: 10.1007/s12630-020-01912-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/21/2020] [Accepted: 12/21/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- Jason K Panchamia
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Denzil Hill
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Basel Sharaf
- Department of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN, USA
| | - Adam W Amundson
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
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Neha S, Karthick KS. Inadvertent strangulation of inflation line of the pilot balloon during submental endotracheal intubation: a rare complication. J Clin Monit Comput 2020; 35:449-451. [PMID: 32266519 DOI: 10.1007/s10877-020-00508-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 03/31/2020] [Indexed: 11/27/2022]
Abstract
Submental intubation is the preferred type of intubation in patients with complex maxillofacial fractures where oral or nasal intubation cannot be performed. It is also less invasive than tracheostomy in securing the airways. We report a case where an inadvertent strangulation of inflation line of the pilot balloon resulted in inadequate ventilation during submental intubation.
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Affiliation(s)
- Singh Neha
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Bhubaneswar, Odisha, 751019, India.
| | - Kumar Sabari Karthick
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Bhubaneswar, Odisha, 751019, India
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Submental intubation in oral and maxillofacial surgery: a systematic review 1986–2018. Br J Oral Maxillofac Surg 2020; 58:43-50. [DOI: 10.1016/j.bjoms.2019.10.314] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 10/25/2019] [Indexed: 01/04/2023]
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Clinical Anatomy of Submental Intubation: A Review of the Indications, Technique, and a Modified Approach. Ann Plast Surg 2019; 84:232-237. [PMID: 31335466 DOI: 10.1097/sap.0000000000001948] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Since its original description in 1986 by Hernandez, submental intubation has been used in a wide variety of craniomaxillofacial cases as a way to satisfy both surgeon and anesthesiologist to provide access to necessary surgical sites and airway protection. Many modifications to the original technique have been described. There has been a paucity of plastic surgery literature over the last 10 years that have reviewed the anatomy, technique, and complications. In this article, the authors review the pertinent anatomy related to this method of intubation. A cadaver was used to enhance visualization of important structures and to show the modification used by our group. Submental intubation provides a useful alternative to tracheostomy in several craniomaxillofacial procedures. Our approach uses a reinforced endotracheal tube to prevent kinking and provide additional intraoperative protection of the airway. Submental intubation may be indicated in select patients undergoing craniomaxillofacial surgery. Therefore, it is pertinent to be aware of the important anatomy and the complications of this technique to appropriately counsel patients. Our modification provides safe airway control.
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Molins G, Valls A, Guijarro-Martínez R, Masiá J, de Nadal M, Hernández-Alfaro F. Simultaneous orthognathic surgery and rhinoplasty under nasotracheal intubation. J Clin Anesth 2018; 55:24-25. [PMID: 30590186 DOI: 10.1016/j.jclinane.2018.12.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 11/07/2018] [Accepted: 12/18/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Gloria Molins
- Anestalia - Centro Médico Teknon, c/Vilana, 12, Barcelona 08017, Spain.
| | - Adaia Valls
- Instituto Maxilofacial, Centro Médico Teknon, c/Vilana, 12, Barcelona 08017, Spain.
| | | | - Jorge Masiá
- Instituto Maxilofacial, Centro Médico Teknon, c/Vilana, 12, Barcelona 08017, Spain
| | - Miriam de Nadal
- Hospital Universitario Valle de Hebrón, Paseo del Valle de Hebrón, 119, Barcelona 08035, Spain.
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Oshima N, Shiraishi T, Kawauchi T, Oba J, Sato D, Fujiki M, Ozaki M, Takushima A, Harii K. A Simple and Reliable Submental Intubation Technique for Maxillofacial Fractures. J Craniofac Surg 2018; 29:1952-1955. [PMID: 30113420 PMCID: PMC6200376 DOI: 10.1097/scs.0000000000004628] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 04/01/2018] [Indexed: 11/26/2022] Open
Abstract
In 1986, Altemir first reported the use of submental intubation to avoid tracheotomy in patients with panfacial and midfacial fractures for whom intermaxillary fixation is necessary, but orotracheal and nasotracheal intubations are not recommended. This novel technique allowed intraoperative access to perform dental occlusion and reconstruction of the nasal pyramid in patients with skull base fractures. Herein, we describe a refined technique based on Altemir's original procedure. Seven male patients with panfacial fractures underwent submental intubation using our refined technique. The technique was developed after encountering a technical error with Altemir's original procedure. In this new technique, we employed a 2-0 silk suture guide to allow the passage of both the endotracheal and cuff-inflation tubes through the same tunnel created from the oral cavity to the submental area. The success rate of the refined technique was 100%, and there were no intraoperative or postoperative complications. There was 20 seconds of ventilation outage time in total. Endotracheal and cuff-inflation tubes were easily and quickly passed through the same submental tunnel. Our refined technique is simple, easy, safe, fast, inexpensive, and does not require specific materials. Submental scars were smaller and relatively inconspicuous in this study, compared to those reportedly associated with other modified techniques.
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Affiliation(s)
- Naoya Oshima
- Department of Plastic Surgery, Kyorin University School of Medicine, Shinkawa, Mitaka, Tokyo, Japan
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Fernandes M, Eufrásio A, Bonifácio J, Marcelino J. Airway management in a patient with Crouzon syndrome proposed to orthognathic surgery. BMJ Case Rep 2018; 2018:bcr-2017-219371. [PMID: 29848516 DOI: 10.1136/bcr-2017-219371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Airway management is one of the most important anaesthetist's skills as major complications of airway management, although rare, can be among the most life threatening in medicine. Crouzon syndrome is a rare condition with physical characteristics that can result in difficult airway manipulation. A correct preanaesthetic evaluation and a planned preinduction strategy should be designed to facilitate intubation.
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Affiliation(s)
- Melissa Fernandes
- Anesthesiology, Centro hospitalar e Universitário Coimbra, Coimbra, Portugal
| | - Ana Eufrásio
- Anesthesiology, Centro hospitalar e Universitário Coimbra, Coimbra, Portugal
| | - João Bonifácio
- Anesthesiology, Centro hospitalar e Universitário Coimbra, Coimbra, Portugal
| | - João Marcelino
- Oral and maxillofacial surgery, Centro hospitalar e Universitário Coimbra Coimbra Portugal
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Submental intubation: A useful alternative for orthognathic surgery in patients with craniofacial malformations. Case report☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1097/01819236-201712001-00012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Submental intubation: A useful alternative for orthognathic surgery in patients with craniofacial malformations. Case report. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1016/j.rcae.2016.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Navas-Aparicio MDC, Díaz y Faz R. Intubación submentoniana: una alternativa útil para cirugía ortognática en pacientes con malformaciones craneofaciales. Informe de caso. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1016/j.rca.2016.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Cheong Y, Kang SS, Kim M, Son HJ, Park J, Kim JM. Submental Intubation in Patients with Complex Maxillofacial Injuries. J Lifestyle Med 2016; 6:68-71. [PMID: 27924286 PMCID: PMC5115205 DOI: 10.15280/jlm.2016.6.2.68] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 07/21/2016] [Indexed: 11/22/2022] Open
Abstract
Airway management in patients with complex maxillofacial injuries is a challenge to anesthesiologists. Submental intubation is a useful technique that is less invasive than tracheostomy in securing the airways where orotracheal and nasotracheal intubation cannot be performed. This procedure avoids the use of tracheostomy and bypasses its associated morbidities. A flexible and kink-resistant reinforced endotracheal tube with detachable universal connector is commonly used for submental intubation. Herein, we report cases involving submental intubation using a reinforced endotracheal tube with a non-detachable universal connector in patients with complex maxillofacial injuries.
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Affiliation(s)
- Yuseon Cheong
- Department of Anesthesiology and Pain Medicine, Kangwon National University Hospital, Chuncheon, Korea
| | - Seong Sik Kang
- Department of Anesthesiology and Pain Medicine, Kangwon National University Hospital, Chuncheon, Korea
| | - Minsoo Kim
- Department of Anesthesiology and Pain Medicine, Kangwon National University Hospital, Chuncheon, Korea
| | - Hee Jeong Son
- Department of Anesthesiology and Pain Medicine, Kangwon National University Hospital, Chuncheon, Korea
| | - Jaewoo Park
- Department of Anesthesiology and Pain Medicine, Kangwon National University Hospital, Chuncheon, Korea
| | - Jeong-Mo Kim
- Department of Oral and Maxillofacial Surgery, Kangwon National University Hospital, Chuncheon, Korea
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Minimally traumatic submental intubation: a novel dilational technique. Eur J Trauma Emerg Surg 2016; 43:359-362. [PMID: 27138007 DOI: 10.1007/s00068-016-0675-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 04/21/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Submental intubation is widely accepted as a safe and effective alternative to nasal intubation or tracheostomy in head and neck surgery patients. Forceful or careless technique can cause significant bleeding and trauma to the soft tissues at this point, increasing the likelihood of troublesome sublingual haematoma. METHODS We describe the use of a percutaneous tracheostomy horn (Cook Medical Blue Rhino®) to allow minimally traumatic submental intubation without the need for serial dilations. A patient with severe midfacial injuries requiring surgery was intubated via a standard oral technique. Following this, submental access was achieved using a novel dilational technique with a tracheostomy dilator. This resulted in a very secure and safe submental intubation and unrestricted access to the entire surgical field. RESULTS The single instrument, one-pass dilation technique to achieve submental intubation was found to be easy, quick, and avoided excessive trauma to the floor of mouth. CONCLUSION Patients will sometimes require a protected airway that allows surgeons unrestricted and simultaneous access to the dental occlusion, oral cavity, midface, and nose. In our case, this simple, easy, and quick adaptation of an established technique using a tracheostomy dilator is an excellent alternative to the traditional blunt dissection used to achieve submental intubation.
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Airway Management of the Patient with Maxillofacial Trauma: Review of the Literature and Suggested Clinical Approach. BIOMED RESEARCH INTERNATIONAL 2015; 2015:724032. [PMID: 26161411 PMCID: PMC4486512 DOI: 10.1155/2015/724032] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 02/10/2015] [Indexed: 11/17/2022]
Abstract
According to the Advanced Trauma Life Support recommendations for managing patients with life-threatening injuries, securing the airway is the first task of a primary caregiver. Airway management of patients with maxillofacial trauma is complex and crucial because it can dictate a patient's survival. Securing the airway of patients with maxillofacial trauma is often extremely difficult because the trauma involves the patient's airway and their breathing is compromised. In these patients, mask ventilation and endotracheal intubation are anticipated to be difficult. Additionally, some of these patients may not yet have been cleared of a cervical spine injury, and all are regarded as having a full stomach and having an increased risk of regurgitation and pulmonary aspiration. The requirements of the intended maxillofacial operation may often preclude the use of an oral intubation tube, and alternative methods for securing the airway should be considered before the start of the surgery. In order to improve the clinical outcome of patients with maxillofacial trauma, cooperation between maxillofacial surgeons, anesthesiologists, and trauma specialists is needed. In this review, we discuss the complexity and difficulties of securing the airway of patients with maxillofacial trauma and present our approach for airway management of such patients.
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