Minimally traumatic submental intubation- a novel dilational technique

Zaman, Iffah; Ujam, Atheer; Perry, Mike

doi:10.1016/j.bjoms.2016.11.143

Cited by 1 publication

(6 citation statements)

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“…As compared to our study, the increased time reported by Saheb et al could be due to the fact that they used serial dilators instead of a single Blue Rhino dilator used by us. Use of a single dilator has been previously reported by Ujam and Perry 17 and Zaman et al, 16 wherein the authors reported minimal traumatic submental intubation with the use of single dilation. The significantly reduced procedure time with Seldinger’s technique could be due to the fact that formation of orocutaneous tract using a needle and dilator is easier as compared to blunt dissection, which requires more forcible manipulation of the tissues.…”

Section: Discussionmentioning

confidence: 79%

“…[23][24][25][26][27] One such modification is the percutaneous Seldinger's technique, first described by Biswas et al 15 and subsequently described in a few case reports. 2,[15][16][17] The original Altemir's technique of submental intubation involves a submental paramedian approach of creating orocutaneous tract. Routinely used surgical instruments are required for performing the procedure using this technique, which, when applied with proper knowledge of the anatomy, avoids injury to the Wharton's duct as well as the submandibular and sublingual salivary glands.…”

Section: Discussionmentioning

confidence: 99%

“…2,17 Moreover, use of a 1-step dilation, instead of serial dilatations, can avoid excessive stretching of tissues, thus avoiding further tissue trauma. 16 The reduced bleeding during submental intubation with Seldinger's technique provided an unhindered access to the field, thus helping in reducing the overall procedure time.…”

Section: Discussionmentioning

confidence: 99%

“…However, Seldinger's technique has been previously described in only few case reports in the literature. 2,[15][16][17] To date, no prospective, randomized controlled trials have demonstrated the efficacy and safety of Seldinger's technique. We thus planned to compare the classic Altemir's method with the newer Seldinger's technique of submental intubation in patients undergoing fixation of complex maxillofacial fractures under general anesthesia, hypothesizing that the Seldinger's technique of submental intubation would be associated with reduced procedure time, decreased procedural bleeding, and minimal scar formation.…”

mentioning

confidence: 99%

“…7,13,14 Seldinger's technique is a lesser known, recently described, and interesting alternative to the classic Altemir's technique, wherein a percutaneous dilatational tracheostomy kit is used to dilate the submental tract, instead of bluntly dissecting it. 2,[15][16][17] This technique is said to be associated with minimal bleeding and less tissue destruction. However, Seldinger's technique has been previously described in only few case reports in the literature.…”

mentioning

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: 79%