Endotracheal Intubation Using Submandibular Approach for Maxillofacial Trauma Patients: Report of 2 Cases

Abstract

The indication for submandibular intubation is the requirement for intraoperative maxillomandibular fixation (MMF) in the presence of injuries that preclude nasotracheal intubation. Thus, We reported 2 cased of endotracheal intubations via submandibular approach that is applicable in patients with skull base fractures for a reliable general anesthesia. Endotracheal intubation via submandibular approach was applied during general anesthetic procedures for open reduction in three patients with Le Fort II, III or nasoorbitoethmoid (NOE) fractures. No complications due to submandibular intubation, such as infection, postoperative scarring, nerve injury, hematoma, bleeding, or orocutaneous fistula, were observed following submandibular intubation. Endotracheal intubation via submandibular approach is effective in patients with skull base fractures. In our method, the tube connector is removed in orotracheal intubation in order to avoiding the tube removal or displacement. The advantages of this method are very simple, safe, and to provide the good operation field. SURGICAL TECHNIQUEOn submandibular approach, tube connector of orotracheal tube is removed, and general anesthesia was guided with orotracheal intubation. It was placed medially to the inferior border of mandible and 2 cm anterior to the mandibular angle, 2 cm in length. This was to avoid damage to marginal mandibular branch of facial nerve.Muscle incision was placed internally to the dermal

A novel technique of submandibular intubation with a camera cable drape: a case report

“…Tracheostomy is an alternative to airway management for panfacial fractures and is commonly performed. However, if prolonged maintenance of the airway or ventilation is not needed, then tracheostomy is not an appropriate alternative [3].…”