Clinical evaluation of submental intubation as an alternative airway management technique in midface osteotomy

Ramaraj, P.N.; Singh, Rakesh Kumar; Sharma, Mandeep; Patil, Vinay; Arjun, K.R.; Roy, Bishnupada

doi:10.1016/j.jormas.2019.01.014

Cited by 5 publications

(3 citation statements)

References 22 publications

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“…13,[27][28][29][30][31][32] Most of these were, however, either retrospective studies or case series. A recent prospective study by Ramaraj et al, 21 conducted on 20 patients requiring orthognathic surgery, reported a mean time of 5.68 ± 1.26 minutes for completing submental intubation using Altemir's technique. Similarly, Shetty et al, 20 in their prospective study on 10 patients with midfacial fractures, reported a mean time of 5.9 minutes for performing Altemir's submental intubation.…”

Section: Discussionmentioning

confidence: 99%

“…We recorded demographic data, time taken to complete the procedure of submental intubation (defined as the time taken from the incision [in classical Altemir's technique] or passing of Seldinger needle [in Seldinger's technique] to reconnecting the breathing system to submentally exteriorized ETT), apnea/ disconnection time (time required for conversion of the oral tube to submental tube), technical difficulties during the procedure like damage to the ETT or its parts, difficulty in dilating the tract or tissue getting stuck in the pilot balloon inflation port, procedural complications (including bleeding, assessed using a scoring system as explained by Ramaraj et al 21 ; grade 1: soakage of 1 gauze 4*4 inch in size; grade 2: soakage of >1 gauze; grade 3: electrocautery required to control bleeding), duration of surgery, any difficulties/complications encountered during extubation like prolonged extubation, inability to extubate, and requirement of postoperative mechanical ventilation, laryngospasm, or bronchospasm. Postoperatively, an observer/surgeon blinded to group allocation recorded the presence of salivary fistula at the time of discharge from the hospital and the scar characteristics at 1-and 3-month follow-up.…”

Section: Data Collectionmentioning

confidence: 99%

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A Prospective, Randomized Comparison of the Classical Altemir’s Method With the Newer Seldinger’s Technique of Submental Intubation

Bhatia

Jain

et al. 2023

Anesthesia &Amp; Analgesia

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BACKGROUND: Submental intubation performed using the classical Altemir’s technique is a well-accepted, safe technique for providing optimal operating field to the maxillofacial surgeon, in cases where either nasotracheal or orotracheal intubation is impossible. We propose a new, percutaneous Seldinger’s technique of submental intubation as an interesting alternative to the classical Altemir’s technique, wherein a percutaneous dilatational tracheostomy kit is used to dilate the submental tract, instead of bluntly dissecting it. We hypothesized that Seldinger’s technique would be associated with reduced procedure time and minimal scar formation in patients with maxillofacial fractures. METHODS: We enrolled 60 patients scheduled to undergo maxillofacial injury fixation under general anesthesia. After consent, the cohort was randomly allocated to undergo submental intubation by either the classical Altemir’s technique or Seldinger’s technique. As our primary objective, we noted the time taken to complete the procedure of submental intubation. Our secondary objectives were the components of primary outcome, such as disconnection/apnea time, bleeding, and technical difficulties during the procedure. We also observed for complications such as presence of salivary fistula/infection at hospital discharge and scar characteristics at 1- and 3-month follow-up. RESULTS: The median time for performing submental intubation in the Seldinger group was significantly lower than that in the Altemir group (170.5 [136.5–256.0] seconds vs 220.0 [205.5–289.0] seconds; P value, .040). The median disconnection time was also significantly lower in the Seldinger group (12.0 [10.8–20.0] seconds vs 19.0 [15.0–23.0] seconds; P value, .036). Furthermore, significant bleeding was absent in nearly 53.8% of the study participants in the Seldinger group as compared to 25.9% in the Altemir group. At follow-up, there was no evidence of differences in scar characteristics between the 2 groups. CONCLUSIONS: Seldinger’s technique is associated with shorter procedure time and reduced apnea time due to easier and better tract formation, thus minimizing the effort required to exteriorize the endotracheal tube. Furthermore, as dilation reduces tissue damage, Seldinger’s technique is associated with significantly less procedural bleeding. Thus, Seldinger’s technique can be safe, easy, and faster to perform compared with the classical Altemir’s technique of submental intubation in patients with maxillofacial trauma.

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Section: Discussionmentioning

confidence: 99%

Section: Data Collectionmentioning

confidence: 99%

A Prospective, Randomized Comparison of the Classical Altemir’s Method With the Newer Seldinger’s Technique of Submental Intubation

Bhatia

Jain

et al. 2023

Anesthesia &Amp; Analgesia

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“…Orotracheal intubation techniques with a submental or submandibular approach represent a low-risk alternative to avoid Research, Society and Development, v. 10, n. 12, e49101220158, 2021 (CC BY 4.0) | ISSN 2525-3409 | DOI: http://dx.doi.org/10.33448/rsd-v10i12.20158 elective tracheostomy (Anwer et al, 2007;Banerjee et al, 2021;Emara et al, 2019;Grando & Puricelli, 1997;Grando & Puricelli, 2004;Grando & Puricelli, 2018;Hassanein, & Abdel Mabood, 2017;Jung et al 2020;Katsnelson et al, 1994;Lim, Parumo & Shanmuhasuntharam, 2018;Martins, Castro, Ferraz, & Simões, 2020;Mishra et al, 2020;Puricelli, 2003;Puricelli, 2005;Ramaraj et al, 2019;Stoll et al, 1994;Surman, Duffy, Anwar, Basyuni, & Santhanam, 2021;Jun et al, 2020). It is also noteworthy that these alternatives require a shorter operative time than elective tracheostomy (Emara et al 2019).…”

Section: Discussionmentioning

confidence: 99%

Submandibular approach for orotracheal intubation in Oral and Maxillofacial Surgery and Traumatology

Puricelli

Ponzoni

2021

RSD

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Introduction: Submandibular tracheal intubation is a technique that can be applied in Oral and Maxillofacial Surgery and Traumatology, as well as other surgical specialties. Its main advantages are helping in the surgical manipulation of the middle facial skeleton and jaw and allowing the intraoperative control of dental occlusion. The technique is an alternative to elective tracheostomy. Objective and case report: The article presents the treatment of an adult patient, with sequelae of multiple fractures in the face due to a car accident, with endotracheal intubation using submandibular approach. Final considerations: In large surgical manipulations of the face, the submandibular approach for tracheal intubation allows a faster, facilitated anatomical access with a lower risk of damage to adjacent structures when compared to other pathways. It also guarantees excellent cervical mobility, the possibility of wide manipulation and the use of occlusion as a guide for surgical intervention.

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A Novel Method of Fixation and Stabilization of the Nasoendotracheal Tube for Maxillary Osteotomies: The Head Cap Technique

Tauro,

Uppada

2024

J. Maxillofac. Oral Surg.

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Clinical evaluation of submental intubation as an alternative airway management technique in midface osteotomy

Cited by 5 publications

References 22 publications

A Prospective, Randomized Comparison of the Classical Altemir’s Method With the Newer Seldinger’s Technique of Submental Intubation

A Prospective, Randomized Comparison of the Classical Altemir’s Method With the Newer Seldinger’s Technique of Submental Intubation

Submandibular approach for orotracheal intubation in Oral and Maxillofacial Surgery and Traumatology

A Novel Method of Fixation and Stabilization of the Nasoendotracheal Tube for Maxillary Osteotomies: The Head Cap Technique

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