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S P S AR, Bhatia N, Jain K, Gupta T, Hazarika A. A Prospective, Randomized Comparison of the Classical Altemir's Method With the Newer Seldinger's Technique of Submental Intubation. Anesth Analg 2023; 137:638-647. [PMID: 37043394 DOI: 10.1213/ane.0000000000006453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
BACKGROUND Submental intubation performed using the classical Altemir's technique is a well-accepted, safe technique for providing optimal operating field to the maxillofacial surgeon, in cases where either nasotracheal or orotracheal intubation is impossible. We propose a new, percutaneous Seldinger's technique of submental intubation as an interesting alternative to the classical Altemir's technique, wherein a percutaneous dilatational tracheostomy kit is used to dilate the submental tract, instead of bluntly dissecting it. We hypothesized that Seldinger's technique would be associated with reduced procedure time and minimal scar formation in patients with maxillofacial fractures. METHODS We enrolled 60 patients scheduled to undergo maxillofacial injury fixation under general anesthesia. After consent, the cohort was randomly allocated to undergo submental intubation by either the classical Altemir's technique or Seldinger's technique. As our primary objective, we noted the time taken to complete the procedure of submental intubation. Our secondary objectives were the components of primary outcome, such as disconnection/apnea time, bleeding, and technical difficulties during the procedure. We also observed for complications such as presence of salivary fistula/infection at hospital discharge and scar characteristics at 1- and 3-month follow-up. RESULTS The median time for performing submental intubation in the Seldinger group was significantly lower than that in the Altemir group (170.5 [136.5-256.0] seconds vs 220.0 [205.5-289.0] seconds; P value, .040). The median disconnection time was also significantly lower in the Seldinger group (12.0 [10.8-20.0] seconds vs 19.0 [15.0-23.0] seconds; P value, .036). Furthermore, significant bleeding was absent in nearly 53.8% of the study participants in the Seldinger group as compared to 25.9% in the Altemir group. At follow-up, there was no evidence of differences in scar characteristics between the 2 groups. CONCLUSIONS Seldinger's technique is associated with shorter procedure time and reduced apnea time due to easier and better tract formation, thus minimizing the effort required to exteriorize the endotracheal tube. Furthermore, as dilation reduces tissue damage, Seldinger's technique is associated with significantly less procedural bleeding. Thus, Seldinger's technique can be safe, easy, and faster to perform compared with the classical Altemir's technique of submental intubation in patients with maxillofacial trauma.
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Affiliation(s)
| | - Nidhi Bhatia
- From the Departments of Anesthesia and Intensive Care
| | - Kajal Jain
- From the Departments of Anesthesia and Intensive Care
| | - Tarush Gupta
- Plastic Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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de Souza AAB, Araújo SCS, Martins GH, de Jesus AO, Amaral MBF, Silveira RL. New Device for Submental Endotracheal Intubation: A Prospective Cohort Study. J Oral Maxillofac Surg 2022; 80:1927-1942. [PMID: 36137556 DOI: 10.1016/j.joms.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 08/18/2022] [Accepted: 08/18/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Silveira et al (2020) described a new device that aims to facilitate submental intubation. This study aimed to verify the clinical complications from using this new device for submental endotracheal compared to the conventional technique. MATERIAL AND METHODS Patients who underwent submental intubation with the orotracheal tube transposition device were compared to those who underwent the conventional technique in a prospective cohort study. The primary predictor variable was intubation technique: conventional versus device-assisted. The primary outcome was total complications (all complications trans and postoperative, were recorded). Secondary variables were 1) age, 2) sex, 3) etiology, 4) race/ethnicity, 5) fracture types, and 6) intubation procedure time. The data were analyzed using descriptive and inferential statistics. Differences were considered statistically significant at P < .05. RESULTS Forty-two cases are described, including 24 cases with the device and 18 cases using the conventional technique. The mean age was 30.5 ± 11.228 years. The majority of patients were of male sex (88%), non-white (64%), and victims of motorcycle accidents (33%). The mean time to perform submental intubation was 9.9 minutes (±2.1293). Nine complications were recorded, including 2 intraoperative (2 tube dislocations) and 7 postoperative (5 unesthetic scars, one localized hematoma, and one skin infection). The technique used did not affect the time to submental intubation (P = .610). There was no association between technique and occurrence of intraoperative (P = .679; RR = 0.75; confidence interval [CI], 0.05-11.2), postoperative (P = .656; RR = 1.000; CI, 0.255-3.922), or total complications (P = .602; RR = 0.938; CI, 0.293-3.003). CONCLUSION The new device proposed seems to be a good option with similar complication rates as compared to conventional submental intubation.
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Affiliation(s)
| | | | - Gustavo Henrique Martins
- Resident, Resident of Oral and Maxillofacial Surgery, Hospital João XXIII/FHEMIG, Belo Horizonte, MG, Brazil
| | | | | | - Roger Lanes Silveira
- Residency Program Director of Oral and Maxillofacial Surgery, Hospital João XXIII/FHEMIG, Belo Horizonte, MG, Brazil; Otorhinolaryngology/Head and Neck Surgery Service, Santa Casa, Belo Horizonte, MG, Brazil
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Mishra R, Yadav D, Tripathi S, Kandel L, Baral PP, Shubham S, Karn A, Dutta K. Submental Intubations in Panfacial Fractures. Clin Cosmet Investig Dent 2020; 12:41-48. [PMID: 32110114 PMCID: PMC7036666 DOI: 10.2147/ccide.s228326] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 01/31/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Airway management in patients with panfacial fracture remains a challenge to anesthesiologists and surgeons. Submental intubation is an effective and less invasive alternative to tracheostomy during intraoperative airway management where orotracheal and nasotracheal intubation are not appropriate options. In addition, submental intubation allows proper access to oronasal airways and occlusion during intraoperative management. Methods The descriptive retrospective study was carried out and evaluated the outcomes of submental intubation in the management of panfacial fracture, complex maxillary or mandible fracture associated with nasal bone fracture and naso-orbito-ethmoid (NOE) fracture. The medical records of 23 patients who received submental endotracheal intubation were reviewed at UCMS College of Dental Surgery, Bhairahawa, Rupandehi, Nepal from March 2014 to December 2018. The following parameters were evaluated: mode of trauma, time required for intubation, accidental extubation, accidental perforation of the pilot balloon during its insertion, period of hospital stay, post-operative complications, such as the healing of submental scars both intraorally and extraorally. Results The submental intubation was successfully done in all patients with minimal obvious post-operative complications. The mode of trauma for majority of cases of panfacial fracture who underwent submental intubation was road traffic accident (69.56%). The mean time required for intubation was 8.43 (±0.84) minutes. No accidental extubations occurred. Accidental perforation of the pilot balloon was seen in one patient (4.35%) during tube manipulation which was managed successfully by changing the tube. The healing of submental scars was uneventful intraorally and extraorally in almost every case. The mean period of hospital stay in patients with submental intubation was 7.95 (±1.49) days. Discussion Submental intubation is an effective and safe method as it is not associated with complications of tracheostomy during management of panfacial fracture, NOE fracture and craniofacial fracture. In addition, it does not interfere with IMF during intraoperative period.
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Affiliation(s)
- Ravish Mishra
- Department of Oral and Maxillofacial Surgery, UCMS College of Dental Surgery, Bhairahawa, Rupandehi, Nepal
| | - Deepak Yadav
- Department of Oral and Maxillofacial Surgery, UCMS College of Dental Surgery, Bhairahawa, Rupandehi, Nepal
| | - Shashank Tripathi
- Department of Oral and Maxillofacial Surgery, UCMS College of Dental Surgery, Bhairahawa, Rupandehi, Nepal
| | - Laxmi Kandel
- Department of Oral and Maxillofacial Surgery, UCMS College of Dental Surgery, Bhairahawa, Rupandehi, Nepal
| | - Pawan Puspa Baral
- Department of Anaesthesiology and Critical Care, Universal College of Medical Sciences, Bhairahawa, Rupandehi, Nepal
| | - Snigdha Shubham
- Department of Conservative Dentistry and Endodontics, UCMS College of Dental Surgery, Bhairahawa, Rupandehi, Nepal
| | - Abhishek Karn
- Department of Forensic Medicine and Toxicology, Universal College of Medical Sciences, Bhairahawa, Rupandehi, Nepal
| | - Kishor Dutta
- Department of Orthodontics and Dentofacial Orthopaedics, UCMS College of Dental Surgery, Bhairahawa, Rupandehi, Nepal
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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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Clinical evaluation of submental intubation as an alternative airway management technique in midface osteotomy. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2019; 120:410-413. [PMID: 30763776 DOI: 10.1016/j.jormas.2019.01.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 01/19/2019] [Accepted: 01/28/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND The conventional endonasal intubation would not allow precise intra-operative assessment of the changes to the nasolabial soft tissue complex. Submental intubation allows accurate measurement of nasolabial soft tissue complex with no interference with the occlusion. METHODOLOGY A clinical prospective study was carried on 20 patients visiting the Oral and Maxillofacial Surgery department diagnosed of dentofacial deformity requiring orthognathic surgery. The patient were intubated by the submental route of anaesthesia. Intraoperatively time taken to perform intubation and bleeding during the surgery was noted. Post-operatively infection, presence or absence of any complications were noted along with the measurement of scar by Vancouver scar scale. RESULTS Out of 20 patients 17 patients required only maxillary osteotomies whereas 3 patients required bimaxillary osteotomy. The mean time taken for intubation was 5.68 ± 1.257 minutes. In all the cases the scar was measured as minimum. 2 patients showed infection at the site of submental intubation after 7th day while after 14th day there was no infection present. No other complication was noted. 19 out of 20 cases showed no interference during the procedure whereas in 1 case mild interference during mandibular movement. CONCLUSION The submental intubation is a very good alternative to nasotracheal intubation in the patients undergoing bimaxillary surgeries or maxillary surgeries. Submental intubation can be chosen whenever possible, as it is easy, takes little time and follow-up is simple, does not result in bleeding or other complications and more importantly does not result in any unaesthetic scar after 3rd month follow up.
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Thirty years of submental intubation: a review. Int J Oral Maxillofac Surg 2018; 47:1161-1165. [PMID: 29731193 DOI: 10.1016/j.ijom.2018.04.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 02/09/2018] [Accepted: 04/17/2018] [Indexed: 11/23/2022]
Abstract
Submental intubation has been used as an alternative to conventional intubation in the field of oral and maxillofacial surgery since its introduction by Francisco Hernández Altemir in 1986. A review of submental intubation was performed using data from all case reports, case-series, and prospective and retrospective studies published between 1986 and 2016. The indications, variations in incision length, incision sites, types of endotracheal tube used, methods of exteriorization, and complications were recorded and analyzed. A total of 70 articles reporting 1021 patients were included. The main indication was maxillofacial trauma (86.9%, n=887), followed by orthognathic surgery (5.8%, n=59), skull base surgery (2.8%, n=29), and rhinoplasty and rhytidectomy (1.5%, n=15). The complication rate was relatively low: 91.0% of patients (n=929) were complication-free. The most common complication was infection, occurring in 3.5% (n=36) of the total number of patients, followed by scarring (1.2%, n=12) and formation of an orocutaneous or salivary fistula (1.1%, n=11). In summary, submental intubation is a good alternative airway with minimal complications.
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Hassanein AG, Abdel Mabood AMA. Can Submandibular Tracheal Intubation Be an Alternative to Tracheotomy During Surgery for Major Maxillofacial Fractures? J Oral Maxillofac Surg 2016; 75:508.e1-508.e7. [PMID: 27886977 DOI: 10.1016/j.joms.2016.10.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 10/08/2016] [Accepted: 10/11/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE During surgery for major maxillofacial fractures, orotracheal intubation can interfere with some surgical procedures and nasal intubation can be contraindicated or impossible. That is why tracheotomy is presented as a solution, although it carries a relatively high incidence of complications. In this study, the use of submandibular tracheal intubation is basically evaluated as an alternative to tracheotomy in such circumstances. MATERIALS AND METHODS This prospective study was performed in patients undergoing surgery for major maxillofacial fractures in which oral intubation and/or nasal intubation have been unsuitable, impossible, or contraindicated. The technique of submandibular intubation was assessed intraoperatively and in the postoperative period. The outcomes and complications are presented. RESULTS The study included 26 patients aged between 14 and 57 years. All patients had mandibular fractures, with 19 midface fractures (73.1%), 11 nasal bone fractures (42.3%), 10 zygomatic bone fractures (38.5%), 9 naso-orbito-ethmoidal fractures (34.6%), and 9 frontobasilar fractures (34.6%). The procedure time ranged from 5 to 12 minutes (mean, 7 minutes 4.6 seconds). Delayed extubation was performed in 15 cases (57.7%) in which the tube was left in place for a period ranging from 8 to 50 hours (mean, 30 hours 24 minutes). The technique has proved to be straightforward and satisfactory. A postoperative superficial infection occurred in 2 patients, whereas hypertrophic scars occurred in another 2 patients. CONCLUSIONS Submandibular endotracheal intubation is straightforward, safe, and quick to carry out. It can be an alternative to tracheotomy as it allows operative techniques and postoperative airway protection without the risks and side effects of tracheotomy.
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Affiliation(s)
- Ahmed Gaber Hassanein
- Lecturer of Maxillofacial and Plastic Surgery, Maxillofacial Head and Neck Surgery Unit, General Surgery Department, Faculty of Medicine, Sohag University, Sohag, Egypt.
| | - Ahmed M A Abdel Mabood
- Lecturer of Anesthesia, Anesthesia Department, Faculty of Medicine, Sohag University, Sohag, Egypt
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Shin YM, Lee ST, Kwon TG. Surgical correction of septal deviation after Le Fort I osteotomy. Maxillofac Plast Reconstr Surg 2016; 38:21. [PMID: 27226966 PMCID: PMC4856713 DOI: 10.1186/s40902-016-0067-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 04/19/2016] [Indexed: 11/17/2022] Open
Abstract
Background The Le Fort I osteotomy is one of the most widely used and useful procedure to correct the dentofacial deformities of the midface. The changes of the maxilla position affect to overlying soft tissue including the nasal structure. Postoperative nasal septum deviation is a rare and unpredicted outcome after the surgery. There are only a few reports reporting the management of this complication. Case Presentation In our department, three cases of the postoperative nasal septum deviation after the Le Fort I osteotomy had been experienced. Via limited intraoral circumvestibular incision, anterior maxilla, the nasal floor, and the anterior aspect of the septum were exposed. The cartilaginous part of the nasal septum was resected and repositioned to the midline and the anterior nasal spine was recontoured. Alar cinch suture performed again to prevent the sides of nostrils from flaring outwards. After the procedure, nasal septum deviation was corrected and the esthetic outcomes were favorable. Conclusion Careful extubation, intraoperative management of nasal septum, and meticulous examination of pre-existing nasal septum deviation is important to avoid postoperative nasal septum deviation. If it existed after the maxillary osteotomy, septum repositioning technique of the current report can successfully correct the postoperative septal deviation.
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Affiliation(s)
- Young-Min Shin
- Department of Dentistry and Oral Surgery, Dong-San Medical Center, Keimyung University, 194, Dong-San Dong, Jung Gu, Taegu City, 700-712 South Korea
| | - Sung-Tak Lee
- Center for Orthognathic surgery, Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University, Samduck 2 Ga, Jung Gu, Daegu, 700-421 South Korea
| | - Tae-Geon Kwon
- Center for Orthognathic surgery, Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University, Samduck 2 Ga, Jung Gu, Daegu, 700-421 South Korea
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Kumar KAJ, Kumar BP, Mohan AP, Masram AK, Tyro D, Gandla D. Assessment of the Efficacy of Submental Intubation in the Management of Midfacial and Panfacial Trauma Patients. J Maxillofac Oral Surg 2015. [PMID: 26225061 DOI: 10.1007/s12663-014-0684-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Securing an airway in maxillofacial injuries remains a challenge and is an important objective on the part of a maxillofacial surgeon to thoroughly understand its management. PURPOSE The aim of this study was to evaluate the efficacy and complications of submental intubation in the management of midfacial/panfacial trauma patients where oro-endotracheal or naso-endotracheal intubation is contraindicated and tracheostomy can be avoided. PATIENTS AND METHODS Twenty patients with maxillofacial injuries were selected for submental intubation who were admitted in Kamineni Hospital, Narketpally, Nalgonda during a 2 year period (2010-2012). The parameters used to assess the efficacy were; restoration of the occlusion, duration of the surgery, presence of scar, presence of infection, damage to vital structures or any post-operative salivary fistula. RESULTS Submental intubation allowed reduction and fixation of all fractures without the interference of the tube during surgical procedure in all of the patients. There were no intra-operative complications and none of the patients required post-operative ventilation. There were no significant post-operative complications. However, in one of the cases (case 4) infection of submental wound was seen and in another case (case 11) salivary fistula was formed. Both the cases were appropriately managed without any difficulty. The submental scar was well accepted by all the patients. CONCLUSION Submental intubation is a safe and extremely useful procedure in severe maxillofacial injuries. It presents a low incidence of operative and post operative complications. It allows both the surgeon and the anaesthetist to deliver a better quality of patient care.
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Affiliation(s)
- K A Jeevan Kumar
- Department of Oral and Maxillofacial Surgery, Kamineni Institute of Dental Sciences, Narketpally, Nalgonda, Andhra Pradesh India
| | - B Pavan Kumar
- Department of Oral and Maxillofacial Surgery, Kamineni Institute of Dental Sciences, Narketpally, Nalgonda, Andhra Pradesh India
| | - A P Mohan
- Department of Oral and Maxillofacial Surgery, Kamineni Institute of Dental Sciences, Narketpally, Nalgonda, Andhra Pradesh India
| | - Aruna Kishore Masram
- Department of Oral and Maxillofacial Surgery, Kamineni Institute of Dental Sciences, Narketpally, Nalgonda, Andhra Pradesh India
| | - David Tyro
- Department of Oral and Maxillofacial Surgery, Kamineni Institute of Dental Sciences, Narketpally, Nalgonda, Andhra Pradesh India
| | - Divya Gandla
- Department of Oral and Maxillofacial Surgery, Kamineni Institute of Dental Sciences, Narketpally, Nalgonda, Andhra Pradesh India
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Khan I, Sybil D, Singh A, Aggarwal T, Khan R. Airway management using transmylohyoid oroendotracheal (submental) intubation in maxillofacial trauma. Natl J Maxillofac Surg 2015; 5:138-41. [PMID: 25937722 PMCID: PMC4405953 DOI: 10.4103/0975-5950.154815] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Successful management of airway in complex maxillofacial injuries is quite challenging. The complications and the post-operative care associated with tracheotomy makes it an unpopular choice for airway management meant solely for surgery in these patients. A retrospective analysis of 12 patients from June 2008 to December 2011, seeking treatment for pan facial fractures who underwent transmylohyoid oroendotracheal (submental) intubation is discussed here. The stepwise procedure is explained along with problems of intubation in pan facial fractures. The advantages, disadvantages and complications of transmylohyoid intubation are discussed and compared with alternative methods of air way management in such cases. This reliable, safe and easy method of airway management gives sterile surgical field without a change of tube.
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Affiliation(s)
- Imran Khan
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India
| | - Deborah Sybil
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India
| | - Anurag Singh
- Department of Dental Surgery, Sir Gangaram Hospital, New Delhi, India
| | - Tarun Aggarwal
- Department of Anesthesia, Sarvodaya Hospital, Ghaziabad, Uttar Pradesh, India
| | - Rizwan Khan
- Department of Orthopaedics, Santosh Medical College and Hospital, Ghaziabad, Uttar Pradesh, India
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Ricour C, Ferri J, Nunes F, Wiel E, Raoul G. [Patient treated with sub-mental intubation for maxillofacial trauma]. ACTA ACUST UNITED AC 2014; 33:593-5. [PMID: 25450733 DOI: 10.1016/j.annfar.2014.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 08/25/2014] [Indexed: 11/28/2022]
Abstract
Maxillo-facial traumas are frequent and most often occur in young patients. Naso-tracheal or orotracheal intubation may be contraindicated in case of combined occlusal fracture and nasal or ethmoido-nasal fracture. This study was carried out a clinical case of a patient treated at the Lille University Hospital for a maxillofacial trauma associating fracture of nose and maxilla. The purpose was to assess the reliability of submental intubation as an alternative to tracheotomy. Submental intubation is a reliable single and safe technique allowing an one-stage surgical treatment in case of complex association of fractures without using tracheotomy. Its use should be implemented on a larger scale.
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Affiliation(s)
- C Ricour
- Service chirurgie maxillo-faciale, hôpital Roger-Salengro, CHRU de Lille, avenue du Pr Émile-Laine, 59037 Lille cedex, France.
| | - J Ferri
- Service chirurgie maxillo-faciale, hôpital Roger-Salengro, CHRU de Lille, avenue du Pr Émile-Laine, 59037 Lille cedex, France
| | - F Nunes
- Service d'anesthésie-réanimation, hôpital Huriez, CHRU de Lille, 59037 Lille, France
| | - E Wiel
- EA 2694, pôle de l'urgence, université Lille Nord de France, CHRU de Lille, 59037 Lille, France
| | - G Raoul
- Service chirurgie maxillo-faciale, hôpital Roger-Salengro, CHRU de Lille, avenue du Pr Émile-Laine, 59037 Lille cedex, France
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Eisemann B, Eisemann M, Rizvi M, Urata MM, Lypka MA. Defining the role for submental intubation. J Clin Anesth 2014; 26:238-42. [DOI: 10.1016/j.jclinane.2013.09.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Revised: 09/04/2013] [Accepted: 09/07/2013] [Indexed: 11/30/2022]
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Tidke AS, Borle RM, Madan RS, Bhola ND, Jadhav AA, Bhoyar AG. Transmylohoid/Submental Endotracheal Intubation in Pan-facial Trauma: A Paradigm Shift in Airway Management with Prospective Study of 35 Cases. Indian J Otolaryngol Head Neck Surg 2014; 65:255-9. [PMID: 24427577 DOI: 10.1007/s12070-012-0505-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Accepted: 02/03/2012] [Indexed: 11/28/2022] Open
Abstract
The present study was planned to assess the efficacy, utility and complications of transmylohoid intubation in facial polytrauma patients, by setting and design: prospective study. This study was conducted between May 2008 and May 2011 and 35 patients of facial polytrauma were included irrespective of sex, caste and religion. All the selected 35 patients were male and the age of patients ranged between 15 to 45 years (mean age 31 years). All the patients were intubated with transmylohoid, orotracheal intubation using an armoured endotracheal tube (ETT). Average time to perform transmylohoid intubation was 15.51 + 1.85 min (mean + standarad deviation). Average time for drawing the ETT transmylohoid from the submental incision was 49.7 + 24.8 s. Mean duration for which the ETT was kept indwelling was 0.37 + 1.03 days. Accidental extubation of ETT was noted in two patients. Minor post operative complications like swelling in the submental area (2 patient), dehiscence of the submental incision (2 patient) and minor infection at the site of submental incision (3 patients) were noticed, which were found to be statistically insignificant. The transmylohoid intubation allowed simultaneous reduction and fixation of all the facial fractures and intraoperative control of dental occlusion without interference from the tube during the surgery without interfering in the maintenance of the anesthesia and air way.
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Affiliation(s)
- Abhishek S Tidke
- Department of Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, DMIMSU, Sawangi (M), Wardha, 442004 Maharashtra India
| | - Rajiv M Borle
- Department of Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, DMIMSU, Sawangi (M), Wardha, 442004 Maharashtra India
| | - Ramnik S Madan
- Department of Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, DMIMSU, Sawangi (M), Wardha, 442004 Maharashtra India
| | - Nitin D Bhola
- Department of Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, DMIMSU, Sawangi (M), Wardha, 442004 Maharashtra India
| | - Anendd A Jadhav
- Department of Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, DMIMSU, Sawangi (M), Wardha, 442004 Maharashtra India
| | - Anjali G Bhoyar
- Department of Prosthodontics, Crown and Bridge and Implantology, Peoples College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh India
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Submental intubation: a retrospective review of 45 cases. Ir J Med Sci 2012; 182:309-13. [PMID: 23224988 DOI: 10.1007/s11845-012-0886-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 11/26/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Airway management in patients undergoing maxillofacial surgery requires special consideration. A number of options including oro- or naso-tracheal intubation and tracheostomy are available. Submental intubation is now a recognised method of airway control during maxillofacial surgery. It provides a secure airway and does not interfere with maxillomandibular fixation or access to naso-orbito-ethmoid fractures. It avoids potential complications associated with nasotracheal intubation and tracheostomy in patients with multiple facial fractures, and obviates the need to alternate between oral and nasal intubation intra-operatively. METHODS This is a ten year retrospective review of patients who underwent submental intubation in a Regional Oral and Maxillofacial Surgery Department. The following variables were recorded: patient gender and age, preoperative diagnosis, duration of intubation, and complications associated with the intubation technique. RESULTS Submental intubation was performed 45 times on 45 patients. There were no complications relating to the submental intubation procedure. CONCLUSION Submental intubation should be considered as an option for airway management in selected cases of craniomaxillofacial surgery. It is a quick and safe technique with minimal morbidity and a low complication rate. It allows access to the maxillofacial skeleton intra-operatively and does not preclude the use of intermaxillary fixation.
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Lazaridis N, Zouloumis L, Tilaveridis I, Lazaridou M, Antoniades K, Dimitrakopoulos I. Retrotuberosity versus submentosubmandibular and median submental intubation: patients with maxillofacial surgery. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 114:S209-15. [DOI: 10.1016/j.oooo.2011.10.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Revised: 09/30/2011] [Accepted: 10/17/2011] [Indexed: 11/29/2022]
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Abstract
Airway management in patients with faciomaxillary injuries is challenging due to disruption of components of upper airway. The anesthesiologist has to share the airway with the surgeons. Oral and nasal routes for intubation are often not feasible. Most patients have associated nasal fractures, which precludes use of nasal route of intubation. Intermittent intraoperative dental occlusion is needed to check alignment of the fracture fragments, which contraindicates the use of orotracheal intubation. Tracheostomy in such situations is conventional and time-tested; however, it has life-threatening complications, it needs special postoperative care, lengthens hospital stay, and adds to expenses. Retromolar intubation may be an option, But the retromolar space may not be adequate in all adult patients. Submental intubation provides intraoperative airway control, avoids use of oral and nasal route, with minimal complications. Submental intubation allows intraoperative dental occlusion and is an acceptable option, especially when long-term postoperative ventilation is not planned. This technique has minimal complications and has better patients’ and surgeons’ acceptability. There have been several modifications of this technique with an expectation of an improved outcome. The limitations are longer time for preparation, inability to maintain long-term postoperative ventilation and unfamiliarity of the technique itself. The technique is an acceptable alternative to tracheostomy for the good per-operative airway access.
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Affiliation(s)
- Sabyasachi Das
- Department of Anaesthesiology, North Bengal Medical College, P.O.-Sushrutanagar, Dist- Darjeeling, West Bengal, India
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Badjate SJ, Shenoi SR, Budhraja NJ, Ingole P. Transmylohyoid orotracheal intubation: case series and review. J Clin Anesth 2012; 24:460-4. [PMID: 22986317 DOI: 10.1016/j.jclinane.2011.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 12/25/2011] [Accepted: 12/27/2011] [Indexed: 11/25/2022]
Abstract
STUDY OBJECTIVE To evaluate the outcome of airway management in patients with complex maxillofacial fracture by submental intubation, time required for intubation, accidental extubation, and postoperative complications. DESIGN Retrospective study. SETTING University-affiliated hospital. MEASUREMENTS The medical records of the 10 patients who underwent submental intubation from December 2008 to June 2011 were reviewed. MAIN RESULTS At the end of the procedure, all 10 patients were extubated without any complications. Postoperatively, only one patient presented with superficial infection of the submental wound. CONCLUSIONS Submental endotracheal intubation is a simple technique with very low morbidity, and may be used as an alternative to tracheostomy in selected cases of maxillofacial trauma.
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Affiliation(s)
- Samprati J Badjate
- Department of Oral and Maxillofacial Surgery, Vidya Shikshan Prasarak Mandal's (V.S.P.M.'s) Dental College and Research Centre, Nagpur-440019, Maharashtra, India.
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Submental intubation: a literature review. Int J Oral Maxillofac Surg 2012; 41:46-54. [DOI: 10.1016/j.ijom.2011.08.002] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Revised: 08/02/2011] [Accepted: 08/18/2011] [Indexed: 11/23/2022]
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Vidya B, Cariappa KM, Kamath AT. Current perspectives in intra operative airway management in maxillofacial trauma. J Maxillofac Oral Surg 2011; 11:138-43. [PMID: 23730059 DOI: 10.1007/s12663-011-0316-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Accepted: 10/18/2011] [Indexed: 10/14/2022] Open
Abstract
OBJECTIVE Maxillofacial trauma presents a complex problem due to the disruption of normal anatomy. In such cases, we anticipate a difficult oral intubation that may hinder intraoperative IMF. Nasal and skull base fractures do not advocate use of nasotracheal intubation. Hence, other anesthetic techniques should be considered in management of maxillofacial trauma patients with occlusal derangement and nasal deformity. This study evaluates the indications and outcomes of anesthetic management by retromolar, nasal, submental intubation and tracheostomy. METHODOLOGY Of the 49 maxillofacial trauma cases reviewed, that required intraoperative IMF, 32 underwent nasal intubation, 9 patients had tracheostomy, 5 patients utilized submental approach and 3 underwent retromolar intubation. RESULTS Among patients who underwent nasal intubation, eight cases needed fiberoptic assistance. In retromolar approach, though no complication was encountered, constant monitoring was mandatory to avoid risk of tube displacement. Consequently, submental intubation required a surgical procedure which could result in a cosmetically acceptable scar. Though invasive, tracheostomy has its benefits for long term ventilation. CONCLUSION Intubation of any form performed in a maxillofacial trauma patient is complex and requires both sound judgement and considerable experience.
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Affiliation(s)
- B Vidya
- Department of Oral and Maxillofacial Surgery, D J College of Dental Sciences and Research, Modinagar, Ghaziabad, UP India
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Sharma RK, Tuli P, Cyriac C, Parashar A, Makkar S. Submental tracheal intubation in oromaxillofacial surgery. Indian J Plast Surg 2011; 41:15-9. [PMID: 19753195 PMCID: PMC2739561 DOI: 10.4103/0970-0358.41105] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Oromaxillofacial surgical procedures present a unique set of problems both for the surgeon and for the anesthesist. Achieving dental occlusion is one of the fundamental aims of most oromaxillofacial procedures. Oral intubation precludes this surgical prerequisite of checking dental occlusion. Having the tube in the field of surgery is often disturbing for the surgeon too, especially in the patient for whom skull base surgery is planned. Nasotracheal intubation is usually contraindicated in the presence of nasal bone fractures seen either in isolation or as a component of Le Fort fractures. We utilized submental endotracheal intubation in such situations and the experience has been very satisfying. MATERIALS AND METHODS The technique has been used in 20 patients with maxillofacial injuries and those requiring Le Fort I approach with or without maxillary swing for skull base tumors. Initial oral intubation is done with a flexo-metallic tube. A small 1.5 cm incision is given in the submental region and a blunt tunnel is created in the floor of the mouth staying close to the lingual surface of mandible and a small opening is made in the mucosa. The tracheal end of tube is stabilized with Magil's forceps, and the proximal end is brought out through submental incision by using a blunt hemostat taking care not to injure the pilot balloon. At the end of procedure extubation is done through submental location only. RESULTS The technique of submental intubation was used in a series of twenty patients from January 2005 to date. There were fifteen male patients and five female patients with a mean age of twenty seven years (range 10 to 52). Seven patients had Le Fort I osteotomy as part of the approach for skull base surgery. Twelve patients had midfacial fractures at the Le Fort II level, of which 8 patients in addition had naso-ethomoidal fractures and 10 patients an associated fracture mandible. Twelve patients were extubated in the theatre. Eight patients had delayed extubation in the post-operative ward between 1 and 3 days postoperatively. CONCLUSION In conclusion, the submental intubation technique has proved to be a simple solution for many a difficult problem one would encounter during oromaxillofacial surgical procedures. It provides a safe and reliable route for the endotracheal tube during intubation while staying clear of the surgical field and permitting the checking of the dental occlusion, all without causing any significant morbidity for the patient. Its usefulness both in the emergency setting and for elective procedures has been proved. The simplicity of the technique with no specialized equipment or technical expertise required makes it especially advantageous. This technique therefore, when used in appropriate cases, allows both the surgeon and the anesthetist deliver a better quality of patient care.
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Affiliation(s)
- Ramesh Kumar Sharma
- Department of Plastic Surgery, Postgraduate Institute of Medical Education and Research Chandigarh, India
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Shenoi RS, Badjate SJ, Budhraja NJ. Submental orotracheal intubation: Our experience and review. Ann Maxillofac Surg 2011; 1:37-41. [PMID: 23482892 PMCID: PMC3591038 DOI: 10.4103/2231-0746.83154] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION In maxillofacial injuries, a choice has often to be made between different ways of intubation when surgical access to fractured nasal bone and simultaneous establishment of occlusion are required. We report our experience with submental intubation in the airway management of complex maxillofacial trauma patients. AIMS To evaluate the outcome of airway management in patients with complex maxillofacial fracture by submental intubation, time required for intubation, accidental extubation, postoperative complications, and to discuss indications, contraindications, advantages and disadvantages of submental intubation. SETTINGS AND DESIGN A retrospective study is designed. MATERIALS AND METHODS The medical records of seven patients who underwent submental intubation from December 2008 to June 2010 were reviewed and no statistical analysis was used. RESULTS At the end of the procedure all seven patients were extubated without any complications. Postoperatively only one patient presented with superficial infection of the submental wound. CONCLUSIONS Submental endotracheal intubation is a simple technique with very low morbidity and can be used as an alternative to tracheostomy in selected cases of maxillofacial trauma.
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Affiliation(s)
- Ramakrishna S. Shenoi
- Department of Oral and Maxillofacial Surgery, V.S.P.M's Dental College and Research, Nagpur, Maharashtra, India
| | - Samprati J. Badjate
- Department of Oral and Maxillofacial Surgery, V.S.P.M's Dental College and Research, Nagpur, Maharashtra, India
| | - Nilima J. Budhraja
- Department of Oral and Maxillofacial Surgery, V.S.P.M's Dental College and Research, Nagpur, Maharashtra, India
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Garg M, Rastogi B, Jain M, Chauhan H, Bansal V. Submental intubation in panfacial injuries: our experience. Dent Traumatol 2010; 26:90-3. [PMID: 20089066 DOI: 10.1111/j.1600-9657.2009.00850.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Panfacial fractures present a unique set of problems to the anaesthesiologist and surgeon. Airway management in panfacial fractures is still a challenge to the anaesthesiologist as all modalities available such as orotracheal intubation, nasotracheal intubation, tracheostomy, etc., have their own advantages and disadvantages. When all the conventional modalities to secure airway seem unsuitable then submental route offers an excellent alternative to manage airway in such patients. Here we describe our experience with submental intubation technique in 10 patients with panfacial injuries over a period of two years.
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Affiliation(s)
- Munish Garg
- Anaesthesiology & Critical Care Department in NSCB Subharti Medical College, Meerut (UP), India.
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Schütz P, Hamed HH. Submental intubation versus tracheostomy in maxillofacial trauma patients. J Oral Maxillofac Surg 2008; 66:1404-9. [PMID: 18571024 DOI: 10.1016/j.joms.2007.12.027] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2007] [Accepted: 12/05/2007] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate the indications and outcomes of airway management by submental intubation or tracheostomy in patients with maxillofacial trauma, and to describe the technique of submental intubation in detail and discuss its latest refinements. PATIENTS AND METHODS Of 356 patients admitted from January 2004 through September 2007 with maxillofacial trauma, 222 were operated on under general anesthesia. Eight patients underwent urgent or elective tracheostomy; 8 patients underwent submental intubation. RESULTS Seven patients with submental intubation were extubated at the end of the procedure. One patient received elective tracheostomy 3 days later. We did not encounter any complications in the tracheostomy group, while 1 case of slight damage to the endotracheal tube occurred in the submental intubation group. CONCLUSIONS Submental endotracheal intubation is a simple technique with very low morbidity and can replace tracheostomy in selected cases of maxillofacial trauma without indication for prolonged ventilation support.
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Affiliation(s)
- Petr Schütz
- Oral and Maxillofacial Surgery Unit, Al-Adan Dental Center and the Oral and Maxillofacial Surgery Department, Ministry of Health, State of Kuwait.
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Nyárády Z, Sári F, Olasz L, Nyárády J. Submental endotracheal intubation in concurrent orthognathic surgery: A technical note. J Craniomaxillofac Surg 2006; 34:362-5. [PMID: 16860564 DOI: 10.1016/j.jcms.2006.04.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2004] [Accepted: 04/10/2006] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Achieving the necessary occlusion for orthognathic surgery is not possible with conventional oral intubation since the tube interferes with the occluding teeth. Sometimes nasotracheal intubation is impossible due to developmental malformations requiring repair. Also, the oral or nasotracheal tube may interfere with the operation or may be damaged during the procedure. In 1986, Hernandez Altemir described a method of submental endotracheal intubation. His intentions were to avoid tracheostomy in maxillofacial trauma cases where short-term intermaxillary fixation was required. PATIENTS Between January 2000 and May 2003, 13 patients were operated on, using submental intubation. Eight of these (three females and five males) had surgery for orthognathic malformations. METHODS The Hernandez Altemir technique was modified to ease the procedure: a sterile nylon guiding tube and the '222 rule' incision were introduced. Eight cases with concurrent complex orthognathic surgery, using this modified technique are reported in this paper. RESULTS There were no operative or postoperative complications related to the procedure. CONCLUSION The technique is easy to use, rapid and free of complications compared to 'alternative' intubation methods (tracheostomy, retromolar location of tube, etc.). Submental scarring is acceptable. It is recommended for orthognathic procedures in selected cases.
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Affiliation(s)
- Zoltán Nyárády
- Department of Dentistry, Oral and Maxillofacial Surgery, University Pécs, Hungary.
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Taglialatela Scafati C, Maio G, Aliberti F, Taglialatela Scafati S, Grimaldi PL. Submento-submandibular intubation: is the subperiosteal passage essential? Experience in 107 consecutive cases. Br J Oral Maxillofac Surg 2005; 44:12-4. [PMID: 16162372 DOI: 10.1016/j.bjoms.2005.07.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2004] [Accepted: 07/13/2005] [Indexed: 11/25/2022]
Abstract
Adequate treatment of panfacial injuries often requires tracheostomy or alternating intubation through the nose and the mouth to keep the field free during the operation. Altemir's submental technique is an attractive option in these patients. We used the method with a slight modification in 107 operations in our unit to treat panfacial injuries. We had a low rate of complications and no increased operative time.
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Affiliation(s)
- C Taglialatela Scafati
- Emergency Department, Unit of Maxillofacial Surgery, A. Cardarelli General Hospital, via A. Cardarelli 9, Naples 80131, Italy.
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Arya VK, Kumar A, Makkar SS, Sharma RK. Retrograde Submental Intubation by Pharyngeal Loop Technique in a Patient with Faciomaxillary Trauma and Restricted Mouth Opening. Anesth Analg 2005; 100:534-537. [PMID: 15673888 DOI: 10.1213/01.ane.0000142126.86492.7d] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Submental intubation is useful for airway management during maxillofacial surgery when both nasal and orotracheal intubation are deemed unsuitable and to avoid a tracheostomy, especially when long-term ventilatory support is not required in the postoperative period. Adequate mouth opening is a prerequisite for all the techniques described for submental intubation, as the initial step is orotracheal intubation. Hence, this procedure has never been reported in a patient with the inability to open the mouth. We describe the technique of retrograde submental intubation with the help of a pharyngeal loop assembly for the first time in a patient with maxillofacial trauma and restricted mouth opening in whom oral and nasal intubations were not possible and tracheostomy was the only alternative. In this case report, with successful retrograde submental intubation, the potential complications associated with a short-term tracheostomy were avoided, as there was no indication for keeping a tracheostomy during the postoperative period.
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Affiliation(s)
- Virendra K Arya
- *Departments of Anaesthesia & Intensive Care and †Plastic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Hernández Altemir F, Hernández Montero S, Moros Peña M. Combitube SA through submental route. A technical innovation. J Craniomaxillofac Surg 2003; 31:257-9. [PMID: 12914712 DOI: 10.1016/s1010-5182(03)00026-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Both endotracheal intubation and the laryngeal mask are already established and have their specific applications. The Combitube SA applied submentally is useful for patients with serious craniomaxillomandibular fractures, particularly those which disturb the occlusion and cause serious haemorrhage with attendant difficulties for intubation. Combitube SA used via the submental route will facilitate fracture reduction and temporary maintenance of fractures, so that bleeding, pain and airway problems may be managed more easily until alternative intubation has been achieved.
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Abstract
Submental tracheal intubation is a simple, quick and effective alternative to oral and nasal tracheal intubation or tracheostomy in the surgical management of selected patients with craniomaxillofacial injuries. It has a low morbidity and it does not impede the surgical field, allowing for temporary maxillo-mandibular fixation (jaw wiring) intra-operatively, and nasal assessment, manipulation and bone grafting, either simultaneously or as an independent procedure. We report 12 cases utilizing this technique in this retrospective study, this includes 11 patients with mid-facial fractures and associated base of skull fractures, and one patient who underwent an elective Le Fort III advancement. The techniques and indications for submental tracheal intubation are described.
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Affiliation(s)
- M Amin
- Kingston & Queen Mary's Hospitals NHS Trust, Kingston-Upon-Thames, Surrey, UK
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Altemir FH. A complication of submandibular intubation in a panfacial fracture patient. J Craniomaxillofac Surg 2002; 30:65. [PMID: 12064887 DOI: 10.1054/jcms.2001.0267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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