Pdf submental orotracheal intubation for maxillofacial. This study was conducted with the aim to evaluate the frequency, indications, and outcomes of airway management by. Submental intubation is an interesting alternative when shortterm postoperative control of airway is desirable with the presence of undisturbed access to oral as well as nasal airways and good dental occlusion in maxillofacial trauma and. An alternative for tracheostomy was first described by hernandez altemir in 1986. The author thinks that submental intubation is an effective way to manage airway in cases of panfacial trauma with concomitant naso orbito ethmoidal fractures and skull base fractures. This procedure consists of exteriorizing an oral endotracheal tube through the floor of the mouth and submental triangle. May 01, 2003 about submental intubation anaesthesia 2002. In all the patients, the submental intubation permitted simultaneous reduction and fixation of all. Midline submental intubation might be the preferred. Airway management in patients with complex maxillofacial injuries is a challenge to anesthesiologists. The submental route for endotracheal intubation consists of pulling the free end of an endotracheal tube universal connector removed through a submental incision, after the usual orotracheal intubation has been performed. Submental intubation offers an alternative to this type of airway management, involving a decreased risk for the patient due to its safety and versatility in treating nasal fractures and reestablishment of dental occlusion. F, submental incision repaired with interrupted 50 nylon sutures.
Retrograde submental intubation by pharyngeal loop. Submental intubation is a reliable single and safe technique allowing an onestage surgical treatment in case of complex association of fractures without using tracheotomy. Sep 25, 2015 this presentation shows the steps required in submental intubation and the advantages of the procedure. Submental orotracheal intubation for maxillofacial surgery. 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. Submental intubation was first described as an alternative route for oral or nasal intubation or tracheostomy in cases of pan facial trauma, other indications such as systemic pathology or cases of simultaneous orthognathic and plastic surgery have been reported gordon and tolstunav, 1995. An anesthetic challenge submit manuscript j anesth crit care open access 2016, 53. Submental intubation in maxillofacial trauma patients. Post graduate institute of medical sciences rohtak 124001, india email. Pdf airway management in patients with faciomaxillary injuries is challenging due to disruption of.
Submental intubation was first reported by francisco hernandez altemir in 1986 as a procedure that could avoid tracheostomy and allow for the concomitant restoration of occlusion and reduction of facial fractures in patients ineligible for nasotracheal intubation 8. Hernandez first described the submental route for endotracheal intubation in 1986 as an alternative airway maneuver for maxillofacial procedures. Alternative technique of intubation retromolar, retrograde. Submental tracheal intubation in oromaxillofacial surgery ramesh kumar sharma, puneet tuli, chacko cyriac, atul parashar, surinder makkar department of plastic surgery, postgraduate institute of medical education and research chandigarh, india. Submental intubation is a useful technique that is less invasive than tracheostomy in securing the airways where orotracheal and nasotracheal intubation cannot be performed.
In these circumstances, submental intubation is a simple and safe procedure that can be carried out. Submental intubation in patients with complex maxillofacial injuries. Alternative technique of intubation retromolar, retrograde, submental and other technique 1. In most of the cases the procedure of submental intubation was uneventful. Submental endotracheal intubation is not free of adverse events and complications. Feb 07, 20 alternative technique of intubation retromolar, retrograde, submental and other technique 1. Submental intubation was performed 45 times on 45 patients. Johns medical college hospital, bengaluru, karnataka, india. It may be difficult to pass the tube through the incision or reattaching the. Submental intubation in paediatric oral and maxillofacial. Evaluation of safety and usefulness of submental intubation. It contains one or two lymph glands, the submental lymph nodes and some small veins. Detailed description of the procedure is discussed in each patient.
A modified submental orotracheal intubation savitha ks. The purpose of this retrospective study was to evaluate the efficacy and complications of this technique compared with tracheostomy. There are certain indications for submental intubation. E, endotracheal tube secured to submental skin with 20 silk suture. There are technical problems with the original technique described. Submental intubation in oral maxillofacial surgery. Sign up to receive the trauma meded newsletter, and get a free copy of my report on how to stay current. This method was recently implemented in the case of a patient with altered nasal anatomy who sustained a mandibular fracture. Full text submental intubations in panfacial fractures ccide. The purpose was to assess the reliability of submental intubation as an alternative to tracheotomy.
Discussion submental intubation can be used in various clinical situations. Submental intubation to facilitate the management of maxillofacial trauma. Retrograde submental intubation by pharyngeal loop technique. Submental intubation in paediatric oral and maxillofacial surgery.
Submental intubation in selected cases of craniomaxillofacial injuries is a useful alternative technique as it avoids some of complications associated with nasal intubation and tracheostomy. Submental intubation in patients with panfacial fractures. It has been used for years, and no serious side effects have been reported3,6. Complications from submental endotracheal intubation. Twentyfive patients underwent submental tracheal intubation since 2001. In patients who require intubation for maxillofacial. Thus,submental intubation is a simple, safe, with low morbidity technique for operative.
Fracture of the base of the skull or the nasoorbital ethmoid complex excludes the option of nasal intubation, while oral intubation would prevent the surgeon from obtaining a proper occlusion. The submental endotracheal intubation may be considered a simple, secure, and effective technique for operative airway control in. Pdf efficacy and complications of submental tracheal. Submental intubation in patients with panfacial fractures medind. Alternative technique ofintubation retromolar, retrograde, submental and other technique under the guidance assistant prof dr. Submental intubation technique for airway during surgery. We describe here our experience with this modified submental intubation that. There were no complications relating to the submental intubation procedure. D, endotracheal tube is shown traversing the floor of mouth and has been exteriorized through the submental incision. Many studies have described submental intubation as a simple, quick, and safe method for airway management1,2,3,5,6,7,8. Assistant professor, department of plastic surgery, saveetha medical college hospital. Submental intubation in oral and maxillofacial surgery a. It allowed uninterrupted surgical access and a secure airway.
Retromolar intubation a simple alternative to submental intubation. A better alternative to tracheostomy in panfacial fractures prasant mohan chandra 1, fareedi mukram ali 2, anuroop singhai 1, anupama mudhol 2, farheen ustad 3 1 department of oral and maxillofacial surgery, rkdf dental college and research centre, bhopal, madhya pradesh, india 2 department of oral and maxillofacial surgery, s. Submental intubation was first described by altemir. 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. Apr 27, 2016 in contrast, rungta8 suggested the technique of retromolar submental intubation for maxillofacial trauma patients. Submental intubation for a midface odontogenic tumor. Seven male patients with panfacial fractures underwent submental intubation. Submental intubation is a safe, effective and time efficient method for securing an airway when increased surgical. Submental intubation allows intraoperative dental occlusion and is an acceptable option, especially when longterm postoperative ventilation is not planned. Submental intubation an alternative to tracheostomy in. The submental incision healed with minimal scarring.
Nov, 2012 hernandez first described the submental route for endotracheal intubation in 1986 as an alternative airway maneuver for maxillofacial procedures. G, appearance of 1cm submental scar 8 weeks after submental orotracheal intubation. Complex midfacial or panfacial injuries often require tracheostomy to ensure a free operative field. A study of submental intubation for anaesthesia in. The submental endotracheal intubation may be considered a simple, secure, and effective technique for operative airway control in major maxillofacial traumas. This leaves the facial bones, mandible, and skull base untouched. Submental intubation allowed simultaneous management of all the fractures. Submental orotracheal intubationa technique for airway. After submental intubation wound after 48 hours discussion the submental intubation technique was found to be satisfactory for both the surgeon and anaesthesiologist. Since that time, several case studies have been performed demonstrating the efficacy of the submental approach. After orotracheal intubation and establishment of the submental tract, the free end of the endotracheal tube was pulled through a submental incision and reconnected to the anesthetic circuit. Because of the tight seal of the connector with the. In 15 patients with panfacial trauma, where orotracheal intubation was not feasible and nasotracheal intubation contra.
Figure 1 schematic diagram showing submental intubation procedure using a tube exchanger. Submental intubation to facilitate the management of. Submental tracheal intubation was performed in cases needing intermaxillary fixation complicated. Alagar raja12 34 1professor, department of anaesthesiology, saveetha medical college hospital, chennai. A modified submental orotracheal intubation keelara shivalingaiah savitha 1, abha rani kujur 2, ms vikram 1, shirley joseph 1 1 department of anaesthesia, st. Submental intubation permitted reduction and fixation of all the fractures without the interference of the tube during surgical procedure in all of the patients. To assess submental route intubation as an alternative technique to a tracheostomy in the management of the airway in craniomaxillofacial trauma, along with an assessment of its morbidity and complications. This technique involves passing an endotracheal tube through the anterior floor of the mouth, and then down the airway. Submental intubation technique for airway during surgery of. Pdf acquisition of a secure airway is an essential element of the operative management.
Forum facial fractures and submental tracheal intubation. Submental intubation provides intraoperative airway control, avoids use of oral and nasal route, with minimal complications. Submental and oral incisions are both closed in layers. Submental intubation in oral and maxillofacial surgery a prospective clinical study. Thus, submental intubation is a simple, safe, with low morbidity technique for operative. Abstractsubmental intubation is a method for airway without trachiotomy. Submental intubation is an interesting alternative when shortterm postoperative control of airway is desirable with the presence of undisturbed access to oral as well as nasal airways and good dental occlusion in maxillofacial trauma and also in assessment of nasolabial complex during elective orthognathic surgeries. This procedure avoids the use of tracheostomy and bypasses its associated morbidities. This presentation shows the steps required in submental intubation and the advantages of the procedure.
Submental intubation is the procedure of choice for panfacial fractures. Submental tracheal intubation is a technique for use in patients with maxillofacial trauma. The purpose of this retrospective study was to evaluate the efficacy and complications of this technique. In addition, submental intubation allows proper access to oronasal airways and occlusion during intraoperative management. Facial plastic surgery clinic by ear, nose and throat journal. It also avoids the need of longer post operative care needed in cases of tracheostomy and thus does away with associated risk of complications. Johns medical college hospital, bengaluru, karnataka, india 2 department of plastic surgery, st. Submental intubation, thus as an alternative to tracheostomy, can be used when shortterm control of airway is desirable with the presence of undisturbed access to oral as well as nasal airways and a good dental occlusion.
All the patients received appropriate reduction of facial fractures following submental intubation with no intraoperative complications. It is especially important for panfacial fractures where mmf is required intraoperatively and. Health, general face care and treatment injuries facial injuries intubation practice usage. Retromolar intubation a simple alternative to submental. All of these patients were initially orally intubated, and then converted to submental intubation prior to the reparative procedure. Shortterm intraoperative intermaxillary fixation required to.
Tracheostomy remains an excellent procedure for esta. The average reported time to complete a submental intubation was 9. It is a quick and safe technique with minimal morbidity and a low complication rate. Exteriorization of the tube can be difficult, and several adjustments to the originally described technique have been proposed. The most critical part is the passage of the endotracheal tube through the incision from the. The mean time required for oral to submental intubation and induction to submental intubation was 1. Defining the role for submental intubation, journal of. Facial fractures and submental tracheal intubation wiley online. Adverse events can occur while the endotracheal tube is passed through the incision from interior to exterior. Hence, this procedure has never been reported in a patient with the inability to open the mouth. Material and methods from july 2003 to february 2005, patients benefited from submental intubation table 1. The submental triangle or suprahyoid triangle is a division of the anterior triangle of the neck boundaries. Hernandez altemir, a maxillofacial surgeon, first described an alternative for tracheostomy in 1986.
Read defining the role for submental intubation, journal of clinical anesthesia on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. Submental intubation for airway management of patients with. Tracheal intubation via the submental route was first described by altemir in 1986. When neither nasotracheal nor orotracheal intubation is suitable, submental intubation is a suitable alternative to the. Submental intubation was successfully performed in 10 patients.
Submental intubation was introduced as a substitute for oral or nasal intubation, especially in extensive maxillofacial injuries. Midline submental intubation might be the preferred alternative to oral and nasal intubation in elective oral and craniomaxillofacial surgery when indicated huijun jin, md,and pavan manohar patil, mds, dnb, fisclpy purpose. Indications for submental intubation are maxillofacial injuries with associated fractures of nasal bone and skull base or use of temporary. Full text submental intubations in panfacial fractures. Submental intubation should be considered as an option for airway management in selected cases of craniomaxillofacial surgery. Submental intubation with paramedian approach has been used in 60 cases. It has a low morbidity and it does not impede the surgical.
No consensus exists to date regarding the best method of controlling the airway for oral or. Submental intubation is an effective and less invasive alternative to tracheostomy during intraoperative airway management where orotracheal and nasotracheal intubation are not appropriate options. This study demonstrated a low rate of complications in submental endotracheal intubation and no increase in operative time within the evaluated sample. Submental intubation is a simple, secure and effective procedure for operative airway control in maxillofacial trauma surgery. This method was recently implemented in the case of a patient with altered nasal anatomy who sustained a mandibular fracture necessitating. A total of 11 patients with maxillofacial trauma admitted during the study period. Keywords intubation submental route anaesthesia after normal oral intubation, an incision measuring approximately 2 cm. Oral intubation can interfere with the assessment of occlusion and nasotracheal intubation may lead to complications brain damage, leakage of cerebrospinal fluid, and meningitis when there are associated fractures of the base of the skull. Herein, we describe a refined technique based on altemirs original procedure. The submental triangle or suprahyoid triangle is a division of the anterior triangle of the neck. Submental intubation steps of the procedure explained.
Submental intubation in maxillofacial surgery journal of oral and. It avoids retromolar intubation tracheostomy and its disadvantages. It has been used for years, and no serious side effects. Of the options available, submental intubation is an alternative to tracheostomy. The access should be accomplished via a midline approach rather than lateral through the mylohyoid, an armored endotracheal tube utilized to prevent kinking, and the passage facilitated by use of wound dilators obtained from a percutaneous tracheostomy set. Either a nasal or oral tube would have been in the way of the surgical field. Submental intubation in oral maxillofacial surgery med oral patol. Submental intubation is an interesting alternative to tracheostomy, especially when shortterm postoperative control of airway is desirable with the presence of undisturbed access to oral as well as nasal airways and a good dental occlusion. Submental intubation europe pmc article europe pmc. Fiberoptic assisted submental endotracheal intubation a. The newsletter is released every 12 months, and delivers four pages packed with trauma information you absolutely need to know. Severe maxillofacial trauma is by far the most common reason to perform submental intubation table 1.
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