Retromolar tracheal tube positioning for patients undergoing faciomaxillary surgery

Dutta, Amitabh; Kumar, Vishal; Saha, Shiv Shankar; Sood, Jayashree; Khazanchi, Rakesh Kumar

doi:10.1007/bf03016082

Cited by 19 publications

(15 citation statements)

References 2 publications

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“…Successful maxillofacial surgeries have been reported in good number of patients using this technique. [10–12] Tooth loss is not infrequent in Le Fort II fractures and this gap can also be utilized to safely harbor the ETT secured on the maxillary side.…”

Section: Introductionmentioning

confidence: 99%

Submental intubation: A journey over the last 25 years

Das¹,

Das²

2012

J Anaesthesiol Clin Pharmacol

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Airway management in patients with faciomaxillary injuries is challenging due to disruption of components of upper airway. The anesthesiologist has to share the airway with the surgeons. Oral and nasal routes for intubation are often not feasible. Most patients have associated nasal fractures, which precludes use of nasal route of intubation. Intermittent intraoperative dental occlusion is needed to check alignment of the fracture fragments, which contraindicates the use of orotracheal intubation. Tracheostomy in such situations is conventional and time-tested; however, it has life-threatening complications, it needs special postoperative care, lengthens hospital stay, and adds to expenses. Retromolar intubation may be an option, But the retromolar space may not be adequate in all adult patients. Submental intubation provides intraoperative airway control, avoids use of oral and nasal route, with minimal complications. Submental intubation allows intraoperative dental occlusion and is an acceptable option, especially when long-term postoperative ventilation is not planned. This technique has minimal complications and has better patients’ and surgeons’ acceptability. There have been several modifications of this technique with an expectation of an improved outcome. The limitations are longer time for preparation, inability to maintain long-term postoperative ventilation and unfamiliarity of the technique itself. The technique is an acceptable alternative to tracheostomy for the good per-operative airway access.

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Section: Introductionmentioning

confidence: 99%

Submental intubation: A journey over the last 25 years

Das¹,

Das²

2012

J Anaesthesiol Clin Pharmacol

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“…A dentist or an oral and maxillofacial surgeon may be the best person to make the decision regarding extraction of the third molar for the sole purpose of creating space for intubation. Dutta et al (2) observed that in adults the retromolar area had enough space for placement of the endotracheal tube in 42 patients undergoing a variety of maxillofacial procedures. However, there is great variation in the retromolar space when third molars are impacted or fully erupted.…”

Section: Discussionmentioning

confidence: 98%

An Evaluation of the Retromolar Space for Oral Tracheal Tube Placement for Maxillofacial Surgery in Children

Arora

Rattan²,

Bhardwaj³

2006

Anesthesia &Amp; Analgesia

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“…Le forte II and III fracture, involving both naso-orbito-ethmoidal complex disruption with occlusal change are ideal cases for this method. 8,9 Its use in craniofacial and orthognathic surgeries was documented by Mertinez-Lage et al 10 The primary indication is space availability in retromolar area, if less then more chances of accidental extubation of ETT.…”

Section: Discussionmentioning

confidence: 99%

Submental intubation in complex craniomaxillofacial trauma cases

Kumar

Chattopadhaya

Dua

et al. 2017

Int J Otorhinolaryngol Head Neck Surg

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Background: Airway management in patient with craniomaxillofacial trauma is challenging due to disruption of components of upper airway. In complex panfacial trauma cases, especially involving naso-orbito-ethmoidal complex, the airway is shared between the maxillofacial surgeon and anaesthesiologist. Often in such severe trauma cases, both nasotracheal and orotracheal intubation are contraindicated. Previously in such situation tracheostomy was the method of choice. Though tracheostomy is time tested it has its fair share of complications, some even life threatening. Other methods were used such as retromolar intubation as an alternative, but it may not be suitable for all such cases. Another approach is submental intubation but not so much in routine practice. A retrospective study was designed to evaluate clinical criteria’s airway management in complex craniomaxillofacial trauma cases using submental intubation.Methods: Datasheets of 14 craniomaxillofacial trauma cases who were intubated with submental intubation method were reviewed. The factors like: ease of anaesthesiologist for carrying out general anaesthesia, ease of surgeon for performing surgery and average time taken during the procedure, intraoperative and postoperative complications were evaluated and charted. Results: Submental intubation provides intraoperative airway control, avoids use of both oral and nasal routes, and allows intraoperative manipulation of occlusion, intramaxillary and intermaxillary fixation. This technique has minimal complications and has better patient, anaesthetists and surgeons acceptability. The limitations of this technique include longer preparation time, inability to maintain long term postoperative ventilation and unfamiliarity of technique itself.Conclusions: This submental intubation can be used with little modifications in a variety of complicated panfacial trauma cases.

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Retromolar tracheal tube positioning for patients undergoing faciomaxillary surgery

Abstract: CORRESPONDENCE 341FIGURE Retromolar placement of the tracheal tube with intermaxillary wire fixation in place.

Cited by 19 publications

References 2 publications

Submental intubation: A journey over the last 25 years

Submental intubation: A journey over the last 25 years

An Evaluation of the Retromolar Space for Oral Tracheal Tube Placement for Maxillofacial Surgery in Children

Submental intubation in complex craniomaxillofacial trauma cases

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