The submental triangle or suprahyoid triangle is a division of the anterior triangle of the neck boundaries. An alternative for tracheostomy was first described by hernandez altemir in 1986. Submental intubation provides intraoperative airway control, avoids use of oral and nasal route, with minimal complications. To assess submental route intubation as an alternative technique to a tracheostomy in the management of the airway in craniomaxillofacial trauma, along with an assessment of its morbidity and complications. Submental intubation in paediatric oral and maxillofacial surgery. Submental intubation is a simple, secure and effective procedure for operative airway control in maxillofacial trauma surgery. Submental intubation was performed 45 times on 45 patients. Submental intubation europe pmc article europe pmc. Defining the role for submental intubation, journal of.
Submental intubation in oral maxillofacial surgery med oral patol. Submental intubation was successfully performed in 10 patients. Submental intubation is an effective and less invasive alternative to tracheostomy during intraoperative airway management where orotracheal and nasotracheal intubation are not appropriate options. Shortterm intraoperative intermaxillary fixation required to. Complications from submental endotracheal intubation.
It avoids retromolar intubation tracheostomy and its disadvantages. Submental intubation should be considered as an option for airway management in selected cases of craniomaxillofacial surgery. A simple and reliable submental intubation technique for max. Submental intubation allowed simultaneous management of all the fractures. Submental intubation technique for airway during surgery of. All the patients received appropriate reduction of facial fractures following submental intubation with no intraoperative complications. An anesthetic challenge submit manuscript j anesth crit care open access 2016, 53. Submental intubation in oral and maxillofacial surgery a prospective clinical study.
Submental intubation permitted reduction and fixation of all the fractures without the interference of the tube during surgical procedure in all of the patients. Full text submental intubations in panfacial fractures ccide. A flexible and kinkresistant reinforced endotracheal tube. Seven male patients with panfacial fractures underwent submental intubation. E, endotracheal tube secured to submental skin with 20 silk suture. Submental intubation is the procedure of choice for panfacial fractures. May 01, 2003 about submental intubation anaesthesia 2002.
This leaves the facial bones, mandible, and skull base untouched. This method was recently implemented in the case of a patient with altered nasal anatomy who sustained a mandibular fracture necessitating. The newsletter is released every 12 months, and delivers four pages packed with trauma information you absolutely need to know. We describe here our experience with this modified submental intubation that. In most of the cases the procedure of submental intubation was uneventful. Forum facial fractures and submental tracheal intubation. Submental intubation, thus as an alternative to tracheostomy, can be used when shortterm control of airway is desirable with the presence of undisturbed access to oral as well as nasal airways and a good dental occlusion. In addition, submental intubation allows proper access to oronasal airways and occlusion during intraoperative management. In 15 patients with panfacial trauma, where orotracheal intubation was not feasible and nasotracheal intubation contra. The purpose of this retrospective study was to evaluate the efficacy and complications of this technique. Submental intubation for a midface odontogenic tumor. The submental incision healed with minimal scarring.
In patients who require intubation for maxillofacial. Material and methods from july 2003 to february 2005, patients benefited from submental intubation table 1. Submental intubation in maxillofacial surgery journal of oral and. Thus,submental intubation is a simple, safe, with low morbidity technique for operative. Submental tracheal intubation in oromaxillofacial surgery ramesh kumar sharma, puneet tuli, chacko cyriac, atul parashar, surinder makkar department of plastic surgery, postgraduate institute of medical education and research chandigarh, india. When neither nasotracheal nor orotracheal intubation is suitable, submental intubation is a suitable alternative to the.
Submental intubation in oral maxillofacial surgery. G, appearance of 1cm submental scar 8 weeks after submental orotracheal intubation. Retromolar intubation a simple alternative to submental intubation. This procedure avoids the use of tracheostomy and bypasses its associated morbidities. After submental intubation wound after 48 hours discussion the submental intubation technique was found to be satisfactory for both the surgeon and anaesthesiologist. Full text submental intubations in panfacial fractures.
Submental intubation was first described as an alternative route for oral or nasal intubation or tracheostomy in cases of pan facial trauma, other indications such as systemic pathology or cases of simultaneous orthognathic and plastic surgery have been reported gordon and tolstunav, 1995. The submental endotracheal intubation may be considered a simple, secure, and effective technique for operative airway control in. Submental intubation in selected cases of craniomaxillofacial injuries is a useful alternative technique as it avoids some of complications associated with nasal intubation and tracheostomy. Health, general face care and treatment injuries facial injuries intubation practice usage. Hence, this procedure has never been reported in a patient with the inability to open the mouth.
Severe maxillofacial trauma is by far the most common reason to perform submental intubation table 1. Submental intubation in patients with panfacial fractures. Discussion submental intubation can be used in various clinical situations. Sign up to receive the trauma meded newsletter, and get a free copy of my report on how to stay current.
This procedure consists of exteriorizing an oral endotracheal tube through the floor of the mouth and submental triangle. Submental intubation to facilitate the management of maxillofacial trauma. A modified submental orotracheal intubation savitha ks. It is a quick and safe technique with minimal morbidity and a low complication rate. Submental intubation allows intraoperative dental occlusion and is an acceptable option, especially when longterm postoperative ventilation is not planned. Submental tracheal intubation was performed in cases needing intermaxillary fixation complicated. This study demonstrated a low rate of complications in submental endotracheal intubation and no increase in operative time within the evaluated sample.
Feb 07, 20 alternative technique of intubation retromolar, retrograde, submental and other technique 1. The purpose of this retrospective study was to evaluate the efficacy and complications of this technique compared with tracheostomy. In these circumstances, submental intubation is a simple and safe procedure that can be carried out. The mean time required for oral to submental intubation and induction to submental intubation was 1. Submental orotracheal intubation for maxillofacial surgery. Complex midfacial or panfacial injuries often require tracheostomy to ensure a free operative field. Thus, submental intubation is a simple, safe, with low morbidity technique for operative.
Of the options available, submental intubation is an alternative to tracheostomy. Airway management in patients with complex maxillofacial injuries is a challenge to anesthesiologists. This study was conducted with the aim to evaluate the frequency, indications, and outcomes of airway management by. Submental intubation offers an alternative to this type of airway management, involving a decreased risk for the patient due to its safety and versatility in treating nasal fractures and reestablishment of dental occlusion.
Retrograde submental intubation by pharyngeal loop. Read defining the role for submental intubation, journal of clinical anesthesia on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. Submental intubation is a reliable single and safe technique allowing an onestage surgical treatment in case of complex association of fractures without using tracheotomy. The submental route for endotracheal intubation consists of pulling the free end of an endotracheal tube universal connector removed through a submental incision, after the usual orotracheal intubation has been performed.
Submental intubation was first reported by francisco hernandez altemir in 1986 as a procedure that could avoid tracheostomy and allow for the concomitant restoration of occlusion and reduction of facial fractures in patients ineligible for nasotracheal intubation 8. Fiberoptic assisted submental endotracheal intubation a. A better alternative to tracheostomy in panfacial fractures prasant mohan chandra 1, fareedi mukram ali 2, anuroop singhai 1, anupama mudhol 2, farheen ustad 3 1 department of oral and maxillofacial surgery, rkdf dental college and research centre, bhopal, madhya pradesh, india 2 department of oral and maxillofacial surgery, s. A study of submental intubation for anaesthesia in. Abstractsubmental intubation is a method for airway without trachiotomy. Since that time, several case studies have been performed demonstrating the efficacy of the submental approach. Pdf acquisition of a secure airway is an essential element of the operative management. Indications for submental intubation are maxillofacial injuries with associated fractures of nasal bone and skull base or use of temporary. Submental intubation was introduced as a substitute for oral or nasal intubation, especially in extensive maxillofacial injuries. It has been used for years, and no serious side effects have been reported3,6. Submental and oral incisions are both closed in layers. It is especially important for panfacial fractures where mmf is required intraoperatively and. D, endotracheal tube is shown traversing the floor of mouth and has been exteriorized through the submental incision.
Fracture of the base of the skull or the nasoorbital ethmoid complex excludes the option of nasal intubation, while oral intubation would prevent the surgeon from obtaining a proper occlusion. Submental intubation is a safe, effective and time efficient method for securing an airway when increased surgical. Submental intubation to facilitate the management of. Adverse events can occur while the endotracheal tube is passed through the incision from interior to exterior. Facial fractures and submental tracheal intubation wiley online. Submental intubation an alternative to tracheostomy in. No consensus exists to date regarding the best method of controlling the airway for oral or. Submental intubation with paramedian approach has been used in 60 cases. The purpose was to assess the reliability of submental intubation as an alternative to tracheotomy.
Nov, 2012 hernandez first described the submental route for endotracheal intubation in 1986 as an alternative airway maneuver for maxillofacial procedures. There were no complications relating to the submental intubation procedure. Submental intubation is an interesting alternative to tracheostomy, especially when shortterm postoperative control of airway is desirable with the presence of undisturbed access to oral as well as nasal airways and a good dental occlusion. Submental tracheal intubation is a simple, quick and effective alternative to oral and nasal tracheal intubation or tracheostomy in the surgical management of selected patients with craniomaxillofacial injuries. A total of 11 patients with maxillofacial trauma admitted during the study period.
Figure 1 schematic diagram showing submental intubation procedure using a tube exchanger. Pdf efficacy and complications of submental tracheal. The submental triangle or suprahyoid triangle is a division of the anterior triangle of the neck. Submental intubation in patients with panfacial fractures medind. This presentation shows the steps required in submental intubation and the advantages of the procedure. Many studies have described submental intubation as a simple, quick, and safe method for airway management1,2,3,5,6,7,8. Submental intubation in paediatric oral and maxillofacial. It also avoids the need of longer post operative care needed in cases of tracheostomy and thus does away with associated risk of complications. Tracheostomy remains an excellent procedure for esta.
Submental intubation is an interesting alternative when shortterm postoperative control of airway is desirable with the presence of undisturbed access to oral as well as nasal airways and good dental occlusion in maxillofacial trauma and also in assessment of nasolabial complex during elective orthognathic surgeries. This method was recently implemented in the case of a patient with altered nasal anatomy who sustained a mandibular fracture. Herein, we describe a refined technique based on altemirs original procedure. Alagar raja12 34 1professor, department of anaesthesiology, saveetha medical college hospital, chennai. Facial plastic surgery clinic by ear, nose and throat journal. Pdf airway management in patients with faciomaxillary injuries is challenging due to disruption of. Pdf submental orotracheal intubation for maxillofacial. After orotracheal intubation and establishment of the submental tract, the free end of the endotracheal tube was pulled through a submental incision and reconnected to the anesthetic circuit. Submental intubation was first described by altemir. Retromolar intubation a simple alternative to submental. Because of the tight seal of the connector with the. The average reported time to complete a submental intubation was 9.
Johns medical college hospital, bengaluru, karnataka, india 2 department of plastic surgery, st. Alternative technique of intubation retromolar, retrograde. Submental intubation is a useful technique that is less invasive than tracheostomy in securing the airways where orotracheal and nasotracheal intubation cannot be performed. It may be difficult to pass the tube through the incision or reattaching the. Oral intubation can interfere with the assessment of occlusion and nasotracheal intubation may lead to complications brain damage, leakage of cerebrospinal fluid, and meningitis when there are associated fractures of the base of the skull. This technique involves passing an endotracheal tube through the anterior floor of the mouth, and then down the airway. Submental tracheal intubation is a technique for use in patients with maxillofacial trauma. Tracheal intubation via the submental route was first described by altemir in 1986. There are certain indications for submental intubation. Submental intubation steps of the procedure explained. Assistant professor, department of plastic surgery, saveetha medical college hospital.
Detailed description of the procedure is discussed in each patient. Sep 25, 2015 this presentation shows the steps required in submental intubation and the advantages of the procedure. The author thinks that submental intubation is an effective way to manage airway in cases of panfacial trauma with concomitant naso orbito ethmoidal fractures and skull base fractures. Midline submental intubation might be the preferred. Submental intubation in oral and maxillofacial surgery a. Retrograde submental intubation by pharyngeal loop technique. F, submental incision repaired with interrupted 50 nylon sutures. All of these patients were initially orally intubated, and then converted to submental intubation prior to the reparative procedure. Submental intubation in maxillofacial trauma patients. The access should be accomplished via a midline approach rather than lateral through the mylohyoid, an armored endotracheal tube utilized to prevent kinking, and the passage facilitated by use of wound dilators obtained from a percutaneous tracheostomy set. Hernandez altemir, a maxillofacial surgeon, first described an alternative for tracheostomy in 1986.
Submental intubation for airway management of patients with. In all the patients, the submental intubation permitted simultaneous reduction and fixation of all. Submental endotracheal intubation is not free of adverse events and complications. Submental intubation in patients with complex maxillofacial injuries. The most critical part is the passage of the endotracheal tube through the incision from the. It allowed uninterrupted surgical access and a secure airway. Alternative technique of intubation retromolar, retrograde, submental and other technique 1. It has been used for years, and no serious side effects. Submental intubation is an interesting alternative when shortterm postoperative control of airway is desirable with the presence of undisturbed access to oral as well as nasal airways and good dental occlusion in maxillofacial trauma and. A modified submental orotracheal intubation keelara shivalingaiah savitha 1, abha rani kujur 2, ms vikram 1, shirley joseph 1 1 department of anaesthesia, st. Evaluation of safety and usefulness of submental intubation. It has a low morbidity and it does not impede the surgical.
Midline submental intubation might be the preferred alternative to oral and nasal intubation in elective oral and craniomaxillofacial surgery when indicated huijun jin, md,and pavan manohar patil, mds, dnb, fisclpy purpose. Exteriorization of the tube can be difficult, and several adjustments to the originally described technique have been proposed. There are technical problems with the original technique described. Hernandez first described the submental route for endotracheal intubation in 1986 as an alternative airway maneuver for maxillofacial procedures. It contains one or two lymph glands, the submental lymph nodes and some small veins. Johns medical college hospital, bengaluru, karnataka, india. Submental orotracheal intubationa technique for airway. Either a nasal or oral tube would have been in the way of the surgical field. Submental intubation journal of anaesthesiology clinical.
Keywords intubation submental route anaesthesia after normal oral intubation, an incision measuring approximately 2 cm. The submental endotracheal intubation may be considered a simple, secure, and effective technique for operative airway control in major maxillofacial traumas. Twentyfive patients underwent submental tracheal intubation since 2001. We describe the technique of retrograde submental intubation with the help of a pharyngeal loop assembly for the first time in a patient with maxillofacial trauma and restricted. Post graduate institute of medical sciences rohtak 124001, india email.
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