Airway Management in Maxillofacial Trauma: Do We Really Need Tracheostomy/Submental Intubation

Abstract

Background: There are various techniques available for airway management in patients with maxillofacial trauma. Patients with panfacial injuries may need surgical airway access like submental intubation or tracheostomy, which have their associated problems. We have been managing these types of cases by a novel technique, i.e, intraoperative change of nasotracheal to orotracheal intubation.

Management of Panfacial Fracture

“…There are four established mechanisms for the airway: oral intubation, nasal intubation, submental intubation, and a tracheostomy. 1 The latter three of these intubations allows for mandib-ular-maxillary fixation with full dentition. Oral intubation is possible when there is an absence of occlusion or absent teeth that allows the oral tube to be placed posteriorly in the mouth.…”

“…Of course, there are concerns about postoperative tracheostomy-related complications; however, the risk of tracheostomy is relatively low when compared with the risk of airway management postoperatively. 1 Once the airway has been established, the repair of panfacial injuries follows a systematic approach. There are different philosophies about inside-out or bottom-up versus outside-in or top-down approaches.…”

Airway Management in Facial Trauma Patients

“…Once initial airway management has secured oxygenation, it may become necessary to change to a different ventilation mode for surgical procedures pre-or intraoperatively. 26,42 Changing from a nasal to an oral tube or vice versa is equally feasible. 26,43 The authors strongly advise proceeding under visual control, avoiding blind placement and protrusion of instruments and endotracheal tubes.…”

“…26,42 Changing from a nasal to an oral tube or vice versa is equally feasible. 26,43 The authors strongly advise proceeding under visual control, avoiding blind placement and protrusion of instruments and endotracheal tubes. The unpredictable and frequently impressive dynamic swelling of the airway should not be underestimated.…”

“…14,[20][21][22][23] The transnasal route is chosen, because patients better tolerate the transnasal passage of the tube after decongestion and topical anesthesia of the nasal mucosa (we use 0.5 mL of a 10% cocaine hydrochloride solution) compared with the transoral route. 24 Epistaxis and fractures of the skull base need not to be contraindications, 25,26 as long as the endoscope and the tube are inserted and advanced under visual control and not in a blind way.…”