Efficacy and complications of submental tracheal intubation compared with tracheostomy in maxillofacial trauma patients

Submental intubation in oral and maxillofacial surgery: a systematic review 1986–2018

“…Four compared a tracheostomy group (n = 57) with a submental intubation group (n = 50). [26][27][28][29] Indications A total of 111 studies (2229 cases) reported indications for submental intubation (Table, supplementary data online only). One of them did not report sample size.…”

“…61 The mean (range) time to complete the procedure was 10 (2 62 -37) minutes. 26 The three largest studies comprising 400, 63 120, 36 and 107 cases, 64 also independently reported mean times of 10 minutes. Intubation time was reported only for endotracheal tubes; there were no data for laryngeal mask airways or combitubes.…”

“…Modifications included awake conversion from oral to submental intubation (n = 12), 46 use of a dilator instead of dissection to enlarge the submental passage (n = 7), [47][48][49] and a retrograde technique with an adjunctive pharyngeal loop for restricted mouth opening (n = 1). 50 Exteriorisation may be facilitated by a guiding tube (n = 34), 26,51,52 or by the use of a nasal speculum (n = 3), malleable retractor (n = 1), double curved artery forceps (n = 3) 53 or the two-forceps technique (n = 5) 54 to maintain patency of the submental passage; or by covering the end of the tube to maintain its patency (n = 35). 38,[55][56][57] Covering the end of the second tube before insertion orally was also described.…”

“…Two studies with tracheostomy groups reported intubation times: 35.2 minutes for tracheostomy (n = 10) compared with 36.9 minutes for submental intubation (n = 25), 26 and 14 minutes for tracheostomy (n = 9) compared with 8 minutes for submental intubation (n = 5). 29 Intubation time was similar for one-tube (10.1 minutes, n = 1209) and two-tube techniques (9.7 minutes, n = 132), and for reinforced (9.6 minutes, n = 1249) and non-reinforced endotracheal tubes (9.3 minutes, n = 11).…”

Surgical Management of Panfacial Fractures

“…A retrospective study by Kita et al showed that 25 submentally intubated trauma patients had no severe perioperative or long-term complications, whereas 10 tracheostomy patients had major complications (subcutaneous emphysema, granulation formation, and hemorrhage) with cosmetically concerning scars. 16 Rodrigues et al also reported submental intubation has lower complication rates, requires less time, and costs less than tracheostomy. 17 In a prospective study by Shetty et al, all 10 submentally intubated patients did not have intraoperative complications, and motor or sensory deficits, superficial infections, and hypertrophic scarring were not found in all patients up to 6 months postoperatively.…”