Assessment of the Efficacy of Submental Intubation in the Management of Midfacial and Panfacial Trauma Patients

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)(2011)(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.

Submental Intubation

“…The most common description is that of a paramedian incision with blunt dissection through the mylohyoid. 4 The structures at risk via this approach are the lingual nerve and the submandibular duct. An alternate passage is midline through a submental incision as utilized in this case series.…”

Controversies in the Management of the Airway in Panfacial Fractures. Literature review and Algorithm Proposal

“…After its development, it has been used as a first-choice technique for intra-operative airway management in complex maxillofacial injuries by some, with panfacial trauma being one of the most common indications for submental endotracheal intubation. (31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46) Patients are initially orotracheally intubated, and then the tube is passed through the anterior floor of mouth and reconnected to the ventilator. This allows access to the whole of the face without interference.…”

“…Among complications reported, the most significant were accidental extubation (31) or accidental perforation of the pilot balloon in 4.35% of cases (42). Other complications included wound infections, between 2-3.5% (37,41); transient lingual and marginal nerve paraesthesia; bleeding and submental hypertrophic scar 1.45%-3.57% (32,35); orocutaneous fistula; traumatic injuries to the submandibular and sublingual glands or ducts (36) or mucocele formation.…”

Avaliação Da Anatomia Interna E Alterações Anatômicas Em Incisivos Inferiores

“…Os traumas de natureza operatória não são situações raras de se acontecer e a busca por técnicas que diminuam essas complicações, as chamadas técnicas atraumáticas, está sendo cada vez mais intensa. Manobras habituais preconizam um menor trauma, todavia, o uso de alguns instrumentais pode deformar o alvéolo dentário (KUMAR, 2015).…”