Application of Submandibular Intubation as Alternative to Elective Short-Term Tracheotomy for Particular Cases of Oral and Maxillofacial Tumors Resection and Defects Reconstruction

Abstract

Objective: To describe the cases of oral and maxillofacial tumors (OMFT) resection and defects reconstruction under submandibular intubation (SMI) performed in our institution; secondly, to systematically review and analyze the characteristics of studies about SMI in oral and maxillofacial surgery to estimate the incidence rate of complication. Method: Data related to all 6 patients included in this study were prospectively collected from November 2016 to November 2023. The tract for endotracheal tube was created by bluntly dissection from the submandibular area to the floor of mouth. We performed an exhaustive search for studies about SMI using Pubmed, Embase, Proquest, and Chinese Biomedical Literature Database. Meta-analysis of the incidence rate of complication and infection was performed using STATA 14.1. Results: There was a male predominance (87.3%); the mean age was 47.8±16.8 years; squamous cell carcinoma (SCC) was the most frequent diagnosis (33.3%); the mean time of the operation was 237.0±65.2 minutes; the SMI procedure mean time was 5.5±0.9 minutes; and the mean time to extubation 133.3±12.5 minutes. No accident or complication was observed intraoperatively and postoperatively. The systematic review included 22 out of 234 studies screened. The meta-analysis showed an overall complication rate and superficial infection rate of 5.7% and 3.7% in the last 15 years versus 20.2% and 10.6% in over 15 years ago. Conclusion: Submandibular intubation was found technically easy, safe, and effective alternative of elective short-term tracheotomy, orotracheal and nasotracheal intubations in our series of OMFT resection and defects reconstruction.