Does the Retromolar Area Provide Adequate Space for an Oral Endotracheal Tube Without Interfering With Intermaxillary Fixation?

PURPOSE

Traumatic maxillofacial injuries requiring intermaxillary fixation (IMF) traditionally necessitate airway management via tracheostomy or submental intubation. The aim of this study is to understand whether the retromolar space can accommodate passage of a reinforced endotracheal tube (ETT) without interfering with establishing IMF, a technique previously described as retromolar intubation.

METHODS

A retrospective cross-sectional study was created including previously treated facial trauma patients by our department as the study sample. From this group, 3D reconstructed scans were created and used to estimate that dimensions of the retromolar space. The averages of these dimensions were calculated and compared to the area occupied by different sized reinforced ETTs (6.0, 6.5, 7.0, 7.5, 8.0). A 1-sample t-test was used to compare the retromolar areas to each ETT size for all patients and by gender.

RESULTS

Forty-one patients, ages 19-69 years old, treated from July 2010 to November 2018 were included in this study. This included 24 males (21-69yo) and 17 females (19-60yo), with a total of 80 characteristics measured. The retromolar areas calculated were statistically bigger than the reinforced ETT sizes 6.0, 6.5, and 7.0 compared to the average retromolar space area, but not statistically significant for reinforced oral ETT sizes 7.5 and 8.0.

CONCLUSION

Our study results suggest the use of 6.0, 6.5 and 7.0 reinforced ETTs can be positioned in the retromolar space, allowing the surgeon to place a patient in IMF without occlusal interference. This technique could provide an alternative option to submental intubation or tracheostomy.

Helping anesthesiologists understand facial fractures

Injuries to the oral and maxillofacial region are commonly encountered, and the appropriate management of patients with these injuries frequently requires the expertise of an anesthesiologist. Injuries to this region may involve any combination of soft tissue, bone, and teeth. Injuries to these structures often produce anesthesia-related challenges, which must be overcome to achieve optimal outcomes. This article addresses the common challenges faced by anesthesiologists specific to patients with facial fractures.