Submental / Transmylohyoid intubation in maxillofacial surgery: Report of two cases

Abstract

The submental / transmylohyoid intubation technique, as an alternative technique of airway management in oral and maxillofacial surgery, and its modifications, have been widely reported in the literature since it was first described by Altemir in 1986. However, the technique is not yet popular in Nigeria and Africa in general. A report of two cases in which this technique was used in orofacial reconstruction is presented here. The surgical / anesthetic outcome was satisfactory. No complication was seen in the two cases, and healing of the submental wound was uneventful. Submental intubation is a reliable technique of alternative airway management in oral and maxillofacial surgery. The submental / transmylohyoid technique should be considered by both the anesthetist and the maxillofacial surgeon in challenging cases, where an alternative airway technique is required for maxillofacial surgery.

Submental Endotracheal Intubation for Maxillofacial Surgery: A Report of Two Cases

“…However, Submental intubation has an advantage in that, it allows extubation to be done immediately after the operation, and this avoids the trouble of care for the in-situ tracheostomy tube during the postoperative recovery period. [4,16] The time taken (9 and 10 mins) to convert to submental route from oral route in the two cases was comparable to what is in the literature, [12,14] lending further credence to its simplicity especially when compared to tracheostomy.…”

“…[2] Often the maxillofacial surgeon usually needs to perform surgery in areas that would otherwise be obscured by the endotracheal tube, and also, achieving the correct teeth intercuspation is one of the cardinal objective of most oral and maxillofacial procedures. [4] Hence, orotracheal intubation, which is the conventional technique of securing the airway during general anaesthesia, might prove to be a poor choice in this group of patients. Other possible routes of intubation that can be employed are nasotracheal, retromolar, fibre optic or a surgical airway such as tracheostomy, and the submental.…”

“…The submental route of intubation allowed free intraoperative access to the nasal pyramid without endangering patients with fracture of the base of skull and offers no interference to achieving dental occlusion. [4,5] While it avoids tracheal dissection, submental intubation obviates the risk associated with naso-tracheal intubation in patient with facial trauma. Reports by other authors supported Altemir's claim of normal healing of the mucosa of the floor of the mouth, unaffectation of salivary ducts and production of saliva and absence of motor or sensory deficit.…”

Submental intubation: A journey over the last 25 years

“…Similarly, Adeyemo et al . [40] used nylon tube sac to cover the open end of the tube during transfer through the tunnel. The submental route has also been used for the LMA with reinforced tube in specific situations such as laryngotracheal disruption, voice professionals refusing endotracheal intubation, and patients with unstable cervical fractures posted for faciomaxillary surgery.…”

Submental intubation in oral and maxillofacial surgery: a systematic review 1986–2018

“…Those for orthognathic surgery comprised both single-jaw and bimaxillary procedures, as well as adjunctive genioplasty, rhinoplasty, and septoplasty. Those for disease included tumours of the skull base (n = 28), [31][32][33][34][35] nasal disease (n = 7), 36 extensive facial cancer (n = 5), 30,37 basilar invagination (n = 2), 34 cancrum oris (n = 2), 38,39 benign salivary gland tumour (n = 1), 40 nasopalatine cyst (n = 1), 40 odontogenic fibromyxoma (n = 1), 41 oronasal fistula (n = 1), 38 ossifying fibroma (n = 1), 41 ranula (n = 1), 41 and submucous fibrosis (n = 1). 42 Indications in cosmetic surgery included rhinoplasty with rhytidectomy or genioplasty (n = 20), 36,43 post-traumatic deformities (n = 7), 30,37 and burn scarring (n = 1).…”