Submental Intubation in Maxillofacial Procedures: A More Desired Approach Than Nasotracheal Intubation and Tracheostomy

Abstract

To achieve adequate airway management in maxillofacial procedures, the right intubation technique should be employed. This is because the surgeons and the anesthesiologists will need to work in the same surgical field to ensure a successful procedure. The type of intubation method used can either complicate either's role or pose some difficulties in the surgery itself. Nasotracheal intubation and orotracheal intubation may often be contraindicated in different types of maxillofacial surgeries and due to the complications associated with a tracheostomy, this method is often utilized as a last resort. Submental intubation has become very popular and favored alternative and has been associated with fewer complications. This literature review was conducted to explore the indications, complications, and contraindications of the different intubation methods. Sources were gathered from PubMed Central, PubMed, and Google scholar and included articles published between 2012 and 2022. A mix of literature reviews, case base studies, retrospective studies, prospective studies, and a few systematic reviews were examined. It was found that the use of submental intubation was preferred due to its less invasive nature, minimal intraoperatively and postoperatively complications, and greater patient compliance compared to tracheostomy. In addition, it is the best method when Nasotracheal intubation is contraindicated.

Anesthesia for gender-affirming surgery: a practical review

“…Surgeons may request fiberoptic nasal intubation for procedures on the jaw—in these cases, the patient's prior surgical history should be reviewed carefully because recent rhinoplasty or maxillary augmentation may preclude nasal intubation. Additionally, submental intubation is increasingly utilized for nongender-affirming rhinoplasties [35] and maxillary surgeries [36]. Hair transplantation can be performed under local anesthesia.…”

Use of Griggs forceps for submental intubation: A modification of Seldinger’s technique

“…Submental intubation (SMI) is preferred for complex surgery involving the oro-maxillofacial region. [ 1 ] Various modifications have been made to the conventional SMI technique to make the procedure less traumatic and time-consuming. [ 1 ] This correspondence highlights using Griggs forceps to make an oro-cutaneous tunnel for SMI.…”

“…[ 2 ] However, it may have procedural complications, such as damage to the pilot balloon, loss of tract or false tract formation, injury to sublingual ducts, glands, neural and vascular structures, infection, and abscess formation in the submental area. [ 1 ] To overcome these disadvantages, different practitioners have modified the SMI technique, including but not limited to two Kelly forceps techniques, two artery forceps techniques, silk sutures and laparoscopic trochar for tunnelling, and a Ring-Adair-Elwyn tube. [ 2 , 3 ] Seldinger’s technique is a recently described and exciting 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.…”