Transmylohoid/Submental Endotracheal Intubation in Pan-facial Trauma: A Paradigm Shift in Airway Management with Prospective Study of 35 Cases

Abstract

The present study was planned to assess the efficacy, utility and complications of transmylohoid intubation in facial polytrauma patients, by setting and design: prospective study.

Anterior Submandibular Approach for Transmylohyoid Endotracheal Intubation: A Reappraisal with Prospective Study in 206 Cases of Craniomaxillofacial Fractures

“…On peering the literature, we observed significant dearth of prospective studies reporting use of submental/TMI technique in craniomaxillofacial trauma. Including our previous reported study7 and the present study, there are only five studies1213141516 reporting the efficacy in a prospective manner.…”

“…23 The lateral/paramedian approach was endorsed by several authors. 7,[24][25][26][27][28] The main advantage of anterior submandibular approach over the submental approach is that the tube passes through a shorter pathway without interfering with muscles except from the mylohyoid muscle. The risk of infection and formation of an abscess in the tunnel is consequently lower and the risk of damage to important structures such as the lingual nerve and the Wharton's duct can be avoided as long as the tube passes in close contact with the medial surface of the mandible.…”

“…This sample excluded patients who were recruited in our earlier study. 7 A total of 1,207 cases of maxillofacial trauma were reported, out of which 206 patients who fulfilled the aforementioned criteria were recruited in this study. Nasal intubation was not attempted in any of the cases included in this study.…”

“…The patients were excluded from the study if they required prolonged intubation, patients with poly system trauma, and severe neurological deficits. This sample excluded patients who were recruited in our earlier study 7. A total of 1,207 cases of maxillofacial trauma were reported, out of which 206 patients who fulfilled the aforementioned criteria were recruited in this study.…”

Novel alternative for submental intubation - A case report -

“…In our case, the direction was set by inserting the trocar into the initial incision at the passage similar to that applied during conventional blunt dissection. Therefore, the degree of damage with submental intubation is considered to be similar with that occurring during the conventional method [ 10 ]. Moreover, we did not perform blunt dissection, and thus, caused minimal soft tissue damage.…”