Submento-submandibular intubation: Is the subperiosteal passage essential?

Scafati, C. Taglialatela; Maio, Gabriele De; Aliberti, F; Scafati, Salvatore Taglialatela; Grimaldi, Paul L.

doi:10.1016/j.bjoms.2005.07.011

Cited by 51 publications

(19 citation statements)

References 10 publications

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“…[1428] The placement of ETT in the anterior part of the submandibular region and “submento-submandibular” intubation seem more appropriate nomenclatures. [29] In strict midline approach, (both mylohyoid muscles meet in the midline in an avascular plane) the chance of bleeding is less. [30] Moreover, transfer of ETT is easier as structures are less cramped.…”

Section: Modifications Over the Last 25 Yearsmentioning

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: Modifications Over the Last 25 Yearsmentioning

confidence: 99%

Submental intubation: A journey over the last 25 years

Das¹,

Das²

2012

J Anaesthesiol Clin Pharmacol

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“…17,18 Taglialatela et al advocated a close contact with lingual periosteum rather than a subperiosteal dissection. 19 Anaesthetic modifications includes, nylon guiding tubes, use of dilator for widening orocutaneous tunnel, using Sheridan tube, covering the tip of ETT with surgical glove finger to prevent blood from entering the tube during passage through orocutaneous communication, use of LMA (laryngeal mask airway) especially in patients with laryngeal trauma and unstable cervical fracture, using silicone wire reinforced tube, and retrograde intubation in cases with restricted mouth opening. 15,[20][21][22][23][24][25] All cases in this study were intubated using flexo-mettalic ETT, as it is reinforced with shape memory material, making it flexible and kink resistant, allowing it to maintain its patency.…”

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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“…Extraperiosteal dissection in close contact with lingual periosteum of the mandible instead of subperiosteal dissection has been the main modification suggested by Taglialatela et al . [18]…”

Section: Discussionmentioning

confidence: 99%

“…It is an extraoral procedure and reported complications include detachment of pilot balloon or its damage during exteriorization,[2122] damage to the cuff of the tracheal tube,[18] abscess formation in the floor of mouth, infection of the submental wound,[1825] salivary fistula,[26] development of mucocele,[27] and facial scarring. Complications associated with submental intubation are not as severe as seen in tracheostomy and can be avoided by following a proper surgical technique.…”

Section: Discussionmentioning

confidence: 99%

Submental orotracheal intubation: Our experience and review

Shenoi¹,

Badjate²,

Budhraja³

2011

Ann Maxillofac Surg

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Introduction:In maxillofacial injuries, a choice has often to be made between different ways of intubation when surgical access to fractured nasal bone and simultaneous establishment of occlusion are required. We report our experience with submental intubation in the airway management of complex maxillofacial trauma patients.Aims:To evaluate the outcome of airway management in patients with complex maxillofacial fracture by submental intubation, time required for intubation, accidental extubation, postoperative complications, and to discuss indications, contraindications, advantages and disadvantages of submental intubation.Settings and Design:A retrospective study is designed.Materials and Methods:The medical records of seven patients who underwent submental intubation from December 2008 to June 2010 were reviewed and no statistical analysis was used.Results:At the end of the procedure all seven patients were extubated without any complications. Postoperatively only one patient presented with superficial infection of the submental wound.Conclusions:Submental endotracheal intubation is a simple technique with very low morbidity and can be used as an alternative to tracheostomy in selected cases of maxillofacial trauma.

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Submento-submandibular intubation: Is the subperiosteal passage essential?

Cited by 51 publications

References 10 publications

Submental intubation: A journey over the last 25 years

Submental intubation: A journey over the last 25 years

Submental intubation in complex craniomaxillofacial trauma cases

Submental orotracheal intubation: Our experience and review

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