SummarySubmental 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 midfacial 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.Keywords Anaesthesia: equipment; tubes tracheal. Intubation tracheal: submental; complications. Correspondence to: Mr M. Amin E-mail: michaelamin@doctors.org.uk Accepted: 6 February 2002 There are specific problems associated with airway management in patients with midface or panfacial fractures and possible base of skull fractures. Nasal tracheal intubation in these patients is controversial, particularly if performed without the benefits of a fibreoptic bronchoscope, because of the potential complications, including cranial intubation, epistaxis and intracranial or sinonasal infection [1][2][3][4]. Furthermore, comminuted midface or naso-orbito-ethmoidal complex fractures may cause a physical obstruction to the passage of a nasal tube and the tube may interfere with the assessment and reduction of these fractures [5]. It is often necessary during the reduction of facial fractures to establish dental occlusion and perform temporary maxillo-mandibular fixation (jaw wiring) intra-operatively. This precludes the use of an oral tube at this point in the procedure and may therefore necessitate a tube change.Tracheostomy is still considered the treatment of choice for patients with extensive craniomaxillofacial injuries and multisystem trauma and those who require long-term ventilatory support. However, it is associated with significant morbidity and complications such as haemorrhage, surgical emphysema, tube blockage, recurrent laryngeal nerve injury, tracheal stenosis and poor scar appearance [6].An alternative method of establishing an airway in patients who require maxillofacial surgery but who do not require long-term ventilatory support is to perform submental tracheal intubation, the technique being originally described by Hernández Altemir in 1986 [7]. This provides a secure airway and allows unimpeded surgical access to the oral cavity and midface, whilst avoiding the potential complications associated with nasal intubation and tracheostomy. MethodsTo perform this technique, the patient's trachea is intubated orally using an armoured tracheal tube. Prior to this the universal connector must be removed or cut off and replaced with a removable connector to allow easy detachment. Patients who are already intubated must have Anaesthesia, ...

No abstract

No abstract

No abstract