Submental Intubation - A New Approach in Panfacial Trauma

Abstract

ABSTRACT:The submental route for endotracheal intubation is an alternative to nasal intubation or tracheostomy in the surgical management of patients with complex cranio-maxillofacial injuries. The critical indication for submental intubation is the requirement for intraoperative maxillamandibular fixation (MMF) in the presence of injuries that preclude nasal intubation and in a situation where a tracheostomy is not otherwise required. MMF to re-establish dental occlusion is essential for a normal functional result in dentate patients with fractures involving alveolar segments of the jaws. However, MMF precludes orotracheal intubation. Nasotracheal intubation is often used but is contraindicated in the presence of skull base fractures and will interfere with the access to certain fracture types. A tracheostomy has a high potential complication rate and in many patients, an alternative to the oral airway is not required beyond the perioperative period. Submental intubation is a simple and useful technique with low morbidity in selected cases of cranio-maxillofacial trauma.

Airway Management in Pan Facial Fracture: An Outcome Analysis of Elective Tracheostomy and Submental Endotracheal Intubation

“…This type of intubation has the advantage of not interfering with the dental occlusion during surgery, avoiding the NOE area preventing accidental migration of the endotracheal tube into the cranial cavity or meningitis due to nasal instrumentation [7]. Gandhi et al [8] clearly defined the critical indication of SEI as the patient in whom nasal intubation is contraindicated due to severity of the injury and otherwise doesn't require tracheostomy but requires intra-operative maxillomandibular fixation during surgery.…”

“…The pain was recorded as a visual analogue scale pain (VAS-Pain) score of 0-10 where 0 is no pain and 10 is maximum pain. Further VAS was categorized as mild (1-3), moderate (4-7) and severe (8)(9)(10). The VAS pain was evaluated on the third post-operative day and seventh postoperative day.…”