Introduction: Airway management in patients with panfacial fracture remains a challenge to anesthesiologists and surgeons. Submental intubation is an effective and less invasive alternative to tracheostomy during intraoperative airway management where orotracheal and nasotracheal intubation are not appropriate options. In addition, submental intubation allows proper access to oronasal airways and occlusion during intraoperative management. Methods: The descriptive retrospective study was carried out and evaluated the outcomes of submental intubation in the management of panfacial fracture, complex maxillary or mandible fracture associated with nasal bone fracture and naso-orbito-ethmoid (NOE) fracture. The medical records of 23 patients who received submental endotracheal intubation were reviewed at UCMS College of Dental Surgery, Bhairahawa, Rupandehi, Nepal from March 2014 to December 2018. The following parameters were evaluated: mode of trauma, time required for intubation, accidental extubation, accidental perforation of the pilot balloon during its insertion, period of hospital stay, post-operative complications, such as the healing of submental scars both intraorally and extraorally. Results: The submental intubation was successfully done in all patients with minimal obvious post-operative complications. The mode of trauma for majority of cases of panfacial fracture who underwent submental intubation was road traffic accident (69.56%). The mean time required for intubation was 8.43 (±0.84) minutes. No accidental extubations occurred. Accidental perforation of the pilot balloon was seen in one patient (4.35%) during tube manipulation which was managed successfully by changing the tube. The healing of submental scars was uneventful intraorally and extraorally in almost every case. The mean period of hospital stay in patients with submental intubation was 7.95 (±1.49) days. Discussion: Submental intubation is an effective and safe method as it is not associated with complications of tracheostomy during management of panfacial fracture, NOE fracture and craniofacial fracture. In addition, it does not interfere with IMF during intraoperative period.

Fractures of the mandible occur more often than the other facial bones even though the mandible is considered to be one of the strongest and most rigid bones of the facial skeleton. 1 According to Killey and Rowe, mandibular fractures comprise between 40% and 65% of all facial fractures and angle fractures are involved in 25-33% of such fractures. 2,3 Patterns of fracture depend on multiple factors such as the size, direction, nature and surface area of the impacting force, and the biomechanical characteristics of the mandible such as bone density, mass, normal, or pathologic anatomic structures. 4,5 Huelke reported that the relationship between fracture location and the presence of a tooth-bearing area is significant. 6

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BackgroundTo assess, analyze and compare the results of graft uptake using Tragal Cartilage-Perichondrium Composite (TCPC) graft with Temporalis Fascia (TF) graft in patients who undergoing surgery for chronic otitis media - squamous type.MethodsPatients aged 13 years and above with diagnosis of chronic otitis media - squamous type undergoing modified radical mastoidectomy, either primary or revision surgery with grafting of tympanic membrane (TM) and patients undergoing excision of postero-superior retraction pocket (PSRP) were included in this study. Patients were divided in two groups: Group A-patients undergoing TCPC graft and Group B -patients undergoing TF graft. Graft uptake results were assessed between 8-12 weeks of surgery.ResultsIn both Groups there were 30 patients each. In Group A successful graft uptake was seen in 27 patients (90 %) and failure of graft uptake was seen in 3 patients(10 %). In Group B successful graft uptake was seen in 28 patients (93.3 %) and failure in 2 patients (6.67 %).Out of the total 60 patients, 11 patients had PSRP. All 6 patients with PSRP in Group A had successful graft uptake and no retraction. Among the 5 patients with PSRP in Group B all patients had sucessful graft uptake, however, in 2 patients retraction of the tympanic membrane was seen similar to the preoperative findings.ConclusionsThere was no statistical difference (p = 0.433) between the use of temporalis fascia or tragal cartilage perichondrium in patients undergoing surgery for chronic otitis media - squamous type.

Objective: The  objective  of  this  study was to review the cases of epistaxis and audit its management at Patan Hospital. Materials and Methods: This was a retrospective study and an audit carried out in patients admitted for epistaxis in Patan Hospital from August 2012 to August 2014. All the patients with primary epistaxis were included. The data were analyzed in terms of the specific defined parameters and were compared with that of Guy’s Hospital, United Kingdom, of year 2011.Results: Out of 146 patients, 111 had primary epistaxis. Ninety-three patients (83.78%) with primary epistaxis had anterior bleeding and 18 patients (16.21%) had posterior bleeding. The majority of the patients (31.53%) were treated with chemical cautery, followed by anterior nasal packing (27.02%). Eleven patients (10%) underwent sphenopalatine artery cauterization. The data of our hospital were optimal or near optimal in some aspects like documented initial nasal examination, and initial cautery attempt whereas, parameters like re-bleeding rate, surgical intervention and endoscopic nasal examination after cessation of bleeding were found to be sub-optimal.Conclusion: The improvements are required in some aspects of management of epistaxis like decreasing the re-bleeding rate, increasing the timely surgical intervention and compulsory endoscopic evaluation of nasal cavity after cessation of bleeding. This can be attained with adherence to the protocol as proposed. A multi-center audit would be required to develop a common consensus regarding its management.Nepalese Journal of ENT Head and Neck Surgery, Vol. 5, No. 2, 2014, Page: 26-30