Anterior Submandibular Approach for Transmylohyoid Endotracheal Intubation: A Reappraisal with Prospective Study in 206 Cases of Craniomaxillofacial Fractures

Abstract

Despite a paradigm shift in anesthesia and trauma airway management, the craniomaxillofacial fracture (CMF) patients continue to pose a challenge. A prospective study was planned between April 2007 and March 2015 to investigate the safety, efficacy, utility, and complications of anterior submandibular approach for transmylohyoid intubation (TMI) in CMFs using an armored endotracheal tube (ETT). Out of 1,207 maxillofacial trauma cases reported, this study recruited 206 patients (152 males and 54 females) aged between 21 and 60 years. No episode of oxygen desaturation was noted intraoperatively. Mean time to perform TMI was 6 ± 2 minutes. The mean transmylohyoid ETT withdrawal time/disconnection time from ventilator was approximately 1.5 minutes. Accidental partial extubation of ETT was noted in two patients (0.97%), and three patients (1.45%) developed abscess formations at anterior submandibular site which were managed by incision and drainage. The anterior submandibular approach for TMI was successfully used and provided stable airway in all elective CMF surgery cases, where oral or nasal intubations were not indicated/feasible and long-term ventilation support was not required. It permitted simultaneous dental occlusion-guided reduction and fixation of all the facial fractures without interference from the tube during the surgery with unhindered maintenance of the anesthesia and airway. The advantages include easy, swift, efficient, and reliable approach with a small learning curve.

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

“…Screening by title and abstract excluded 128 that were irrelevant, and a further 16 were excluded as the full texts could not be sourced. [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] Assessment of 146 full-text publications found 30 that were irrelevant. The remaining 116 eligible studies consisted of one randomised controlled trial that compared awake and asleep intubation (OCEBM level 3); 61 case series (21 prospective, 25 retrospective, and 15 unspecified), and 40 case reports (n = 101 at OCEBM level 4); six surgical techniques and eight letters (n = 14 at OCEBM level 5) (Table, supplemental data online only).…”

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

“…A study describing one of the largest series with 206 patients reported in India was published by Bhola and colleagues [11]. The average age was 31.61 years and 75% of the patients were males.…”

Manejo de la vía aérea mediante intubación submental en fracturas maxilofaciales

“…Radiografía control posquirúrgica con adecuada reacción de fractura mandibular. te el posoperatorio se ha reportado edema, hematoma, fístula mucocutánea, desarrollar mucocele y fístula orocutánea 1,2,3,11,15 .…”