A modified submental orotracheal intubation

Abstract

In patients with concomitant occurrence of maxillofacial and basilar skull fractures, open reduction and internal fixation is the treatment. It requires intermittent intra operative dental occlusion which precludes oral or nasal intubation. In such cases submental intubation (SMI) is a recognized technique in practice. We describe a modified technique for smooth exteriorization of the endotracheal tube (ETT) during SMI. As the SMI technique is unusual for the performer, emphasis is laid on the applied aspects to minimize probable complications during the procedure. With the modified technique we performed SMI uneventfully on five patients

Intubação submentoniana na cirurgia bucomaxilofacial: relato de casos clínicos

“…Isso ocorre porque após a exteriorização do balonete, a reinserção da pinça hemostática não pode seguir o mesmo caminho. Podendo o balonete ficar encarcerado nos tecidos e romper no fim do procedimento 8,9 .…”

“…Essa complicação levou a muitos cirurgiões elaborar uma alteração da técnica, e sugerir a utilização de duas pinças hemostáticas. Nesta técnica é inserida a primeira pinça hemostática e no momento antes de exteriorizar o balonete, uma segunda hemostática é passada para manter a patencia do túnel e exteriorizar o tubo 9 .…”

“…Outra forma de exteriorização é sugerida com a utilização de um espéculo nasal. Após a dissecação romba dos tecidos submentoniano e punção do assoalho da boca, um espéculo é inserido mantendo a patência do túnel, facilitando a passagem do balonete e do tubo sem danos aos tecidos moles e sem entrada de sangue e tecido mole no interior do tubo 7,9 . Métodos minimamente invasivos para realizar o túnel, com utilização de kits dilatadores para traqueostomia também são uma possibilidade.…”

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

“…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.…”

Submental Endotracheal Intubation for Maxillofacial Surgery: A Report of Two Cases

“…Reports by other authors supported Altemir's claim of normal healing of the mucosa of the floor of the mouth, unaffectation of salivary ducts and production of saliva and absence of motor or sensory deficit. [11][12][13] Some authors also report overall patient satisfaction and it provides a useful alternative to tracheostomy for maintenance of the airway during oral and maxillofacial reconstruction especially following trauma. [5,8,10,14] Knowledge and awareness of submental intubation as an alternate intubation route in oral and maxillofacial reconstruction is still largely unpopular in Africa and in Nigeria as a whole.…”