A modification of sub-mental intubation

Abstract

In patients who have sustained base of skull fractures, the mode of intubation is controversial, with many anaesthetists arguing against nasal intubation. In several maxillofacial procedures temporary intermaxillary fixation (IMF) in the intraoperative period may be essential to achieve optimal results in fixation. For patients with combined facial and base of skull injury, tracheotomy may have to be performed. The submental approach to intubation allows IMF to be used without resort to nasal intubation or tracheotomy. We describe a modification of the original technique which is applicable to any reinforced tracheal tube and which does not compromise the airway.

The submental endotracheal intubation as an alternative to tracheostomy in selected cases of the facial fracture: literature review and technique report.

“…[6,7] Since then, some authors have described modifications of the original technique. [8][9][10][11][12][13][14] The most common indications and contraindications for submental endotracheal intubation are presented in Table 1.…”

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

“…Furthermore, nasotracheal intubation after maxillofacial trauma can result in the passage of the tracheal tube into the cranium with consequent brain damage (10)(11)(12).…”

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

“…Some workers like Green and Moore [41] suggested use of two tubes: a conventional orotracheal tube securing the patient's airway and a second armoured tube passed through the incision, from exterior to interior. Amin et al [42] have described the use of capnography during the process of conversion of orotracheal to submental and throughout the surgery to confirm the position of the tube and to serve as a warning tool against accidental extubation.…”