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Submental intubation: alternative short-term airway management in maxillofacial trauma

  • Kumar, Ravi Raja (Department of Oral and Maxillofacial Surgery, St. Joseph Dental College) ;
  • Vyloppilli, Suresh (Department of Oral and Maxillofacial Surgery, Malankara Orthodox Syrian Church Medical College) ;
  • Sayd, Shermil (Department of Oral and Maxillofacial Surgery, KMCT Dental College and Hospitals) ;
  • Thangavelu, Annamala (Department of Oral and Maxillofacial Surgery, Rajah Muthiah Dental College & Hospital) ;
  • Joseph, Benny (Department of Oral and Maxillofacial Surgery, KMCT Dental College and Hospitals) ;
  • Ahsan, Auswaf (Department of Oral Medicine and Radiology, KMCT Dental College and Hospitals)
  • Received : 2015.12.16
  • Accepted : 2016.03.06
  • Published : 2016.06.30

Abstract

Objectives: To assess submental route intubation as an alternative technique to a tracheostomy in the management of the airway in cranio-maxillofacial trauma, along with an assessment of its morbidity and complications. Materials and Methods: Submental intubation was performed in 17 patients who had maxillofacial panfacial trauma and management was done under general anesthesia during a period of one year from 2013 to 2014 at Departments of Oral and Maxillofacial Surgery and Dentistry, the Malankara Orthodox Syrian Church Medical College, Kochi, India. Results: In all 17 cases, the technique of submental intubation was found to be simple and reliable. Hypertrophic scars were noted in three cases, orocutaneous fistula and mucocele in one case each. All these complications were managed comfortably without significant morbidity to the patient. Conclusion: Submental intubation is a good technique that can be used regularly in the management of the airway in cranio-maxillofacial trauma, but with some manageable complications.

Keywords

References

  1. Shetty PM, Yadav SK, Upadya M. Submental intubation in patients with panfacial fractures: a prospective study. Indian J Anaesth 2011;55:299-304. https://doi.org/10.4103/0019-5049.82685
  2. Markowitz BL, Manson PN. Panfacial fractures: organization of treatment. Clin Plast Surg 1989;16:105-14.
  3. Shumrick KA, Kersten RC, Kulwin DR, Sinha PK, Smith TL. Extended access/internal approaches for the management of facial trauma. Arch Otolaryngol Head Neck Surg 1992;118:1105-12. https://doi.org/10.1001/archotol.1992.01880100097018
  4. Phero JC, Weaver JM, Peskin RM. Anesthesia for maxillofacial/ mandibular trauma. Anesthesiol Clin North Am 1993;11:509-23.
  5. Hernandez Altemir F. The submental route for endotracheal intubation. A new technique. J Maxillofac Surg 1986;14:64-5. https://doi.org/10.1016/S0301-0503(86)80261-2
  6. Castling B, Telfer M, Avery BS. Complications of tracheostomy in major head and neck cancer surgery; a retrospective study of 60 consecutive cases. Br J Oral Maxillofac Surg 1994;32:3-5. https://doi.org/10.1016/0266-4356(94)90162-7
  7. Halfpenny W, McGurk M. Analysis of tracheostomy-associated morbidity after operations for head and neck cancer. Br J Oral Maxillofac Surg 2000;38:509-12. https://doi.org/10.1054/bjom.2000.0310
  8. Alberti PW. Tracheotomy versus intubation. A 19th century controversy. Ann Otol Rhinol Laryngol 1984;93:333-7. https://doi.org/10.1177/000348948409300410
  9. Muhsin WW, Rendell-Baker L. The principles of thoracic anaesthesia, past and present. Oxford: Blackwell Scientific Publications; 1953:44.
  10. Coe TR, Human M. The peri-operative complications of nasal intubation: a comparison of nostril side. Anaesthesia 2001;56:447-50. https://doi.org/10.1046/j.1365-2044.2001.01524.x
  11. Sanuki T, Hirokane M, Kotani J. Epistaxis during nasotracheal intubation: a comparison of nostril sides. J Oral Maxillofac Surg 2010;68:618-21.
  12. Seltzer AP. Complications of nasotracheal intubation. J Natl Med Assoc 1969;61:415-6.
  13. Chandu A, Gibson NS, Smith AC. An unusual complication of naso-tracheal intubation. Int J Oral Maxillofac Surg 2000;29:395. https://doi.org/10.1016/S0901-5027(00)80061-2
  14. Choudhuri AH, Bhatnagar S, Mishra S. Epistaxis after nasotracheal intubation in oral cancer surgeries: a comparison between fibreoptic intubation and conventional technique. Indian J Anaesth 2006;50:275-8.
  15. Amygdalou A, Dimopoulos G, Moukas M, Katsanos C, Katagi A, Mandragos C, et al. Immediate post-operative effects of tracheotomy on respiratory function during mechanical ventilation. Crit Care 2004;8:R243-7. https://doi.org/10.1186/cc2886
  16. Mort TC. Emergency tracheal intubation: complications associated with repeated laryngoscopic attempts. Anesth Analg 2004;99:607-13.
  17. Sise MJ, Shackford SR, Cruickshank JC, Murphy G, Fridlund PH. Cricothyroidotomy for long-term tracheal access. A prospective analysis of morbidity and mortality in 76 patients. Ann Surg 1984;200:13-7. https://doi.org/10.1097/00000658-198407000-00002
  18. Martinez-Lage JL, Eslava JM, Cebrecos AI, Marcos O. Retromolar intubation. J Oral Maxillofac Surg 1998;56:302-5. https://doi.org/10.1016/S0278-2391(98)90103-3
  19. Gonzalez-Garcia R, Rodriguez-Campo FJ, Naval-Gias L, Sastre- Perez J. Oral to nasal endotracheal tube exchange following reconstructive surgery of the oral cavity by means of vascularized free flaps. J Oral Maxillofac Surg 2005;63:1249-50. https://doi.org/10.1016/j.joms.2005.05.316
  20. Anwer HM, Zeitoun IM, Shehata EA. Submandibular approach for tracheal intubation in patients with panfacial fractures. Br J Anaesth 2007;98:835-40. https://doi.org/10.1093/bja/aem094
  21. Adeyemo WL, Ogunlewe MO, Desalu I, Akanmu ON, Ladeinde AL. Submental/transmylohyoid intubation in maxillofacial surgery: report of two cases. Niger J Clin Pract 2011;14:98-101.
  22. Bogi I, Incze F. Submental introduction of tracheal tube in endotracheal anesthesia. (Modified tracheal intubation method for cases of simultaneous maxillofacial injuries and osteotomies). Fogorv Sz 1996;89:3-6.
  23. Taglialatela Scafati C. Mucoceles as a complication of submandibular intubation. J Craniomaxillofac Surg 2004;32:335. https://doi.org/10.1016/j.jcms.2004.06.001
  24. Stranc MF, Skoracki R. A complication of submandibular intubation in a panfacial fracture patient. J Craniomaxillofac Surg 2001;29:174-6. https://doi.org/10.1054/jcms.2001.0201
  25. Nayan S, Kotrashetti SM, Singh R, Mandlik G, Keswani E, Shevale V. Submental approach for oral endotracheal intubation in maxillofacial trauma: a prospective study. Heal Talk 2013;5:26-7.
  26. Ramsey CA, Dhaliwal SS. Retrograde and submental intubation. Atlas Oral Maxillofac Surg Clin North Am 2010;18:61-8.
  27. Green JD, Moore UJ. A modification of sub-mental intubation. Br J Anaesth 1996;77:789-91. https://doi.org/10.1093/bja/77.6.789
  28. Nyarady Z, Sari F, Olasz L, Nyarady J. Submental endotracheal intubation in concurrent orthognathic surgery: a technical note. J Craniomaxillofac Surg 2006;34:362-5. https://doi.org/10.1016/j.jcms.2006.04.003
  29. Mahmood S, Lello GE. Oral endotracheal intubation: median submental (retrogenial) approach. J Oral Maxillofac Surg 2002;60:473-4. https://doi.org/10.1053/joms.2002.31244
  30. Lima SM Jr, Asprino L, Moreira RW, de Moraes M. A retrospective analysis of submental intubation in maxillofacial trauma patients. J Oral Maxillofac Surg 2011;69:2001-5. https://doi.org/10.1016/j.joms.2010.10.017