A simple and reliable submental intubation technique for. Macinnis and baig published a single elective case of simultaneous le fort iii midface advancement and sagittal ramus osteotomy for mandibular setback. Submental intubation provides intraoperative airway control, avoids use of oral and nasal route, with minimal complications. Submental intubation is a simple, safe, useful and effective method to secure airway in major maxillofacial trauma, where oral and nasal endotracheal intubation cannot be performed. 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.
Panfacial fractures or concomitant nasoethmoidal injuries. It is a quick and safe technique with minimal morbidity and a low complication rate. When neither nasotracheal nor orotracheal intubation is suitable, submental intubation is a suitable alternative to the. Submental intubation in oral maxillofacial surgery. The submental incision healed with minimal scarring. In patients who require intubation for maxillofacial. An alternative for tracheostomy was first described by hernandez altemir in 1986. Submental intubation or its modification as retrograde submental intubation was first described in a patient with restricted mouth opening by arya et al. Rearrange individual pages or entire files in the desired order. Pdf merge combine pdf files free tool to merge pdf online. 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. This technique involves passing an endotracheal tube through the anterior floor of the mouth, and then down the airway. Submental intubation with lmafastrach endotracheal tube.
Nov, 2012 hernandez first described the submental route for endotracheal intubation in 1986 as an alternative airway maneuver for maxillofacial procedures. Tracheal intubation via the submental route was first described by altemir in 1986. Submental intubation as an alternative to tracheostomy in patients with midfacial trauma submental intubation is a safe procedure which can be used tabel 1. Indications for submental intubation are maxillofacial injuries with associated fractures of nasal bone and skull base or use of temporary. Submental intubation is an effective and less invasive alternative to tracheostomy during intraoperative airway management where orotracheal and nasotracheal intubation are not appropriate options. Anesthesiology january april 2000 left molar approach improves the view in difficult laryngoscopy. It provides added advantage of control of occlusion during the panfacial trauma management. There are technical problems with the original technique described. Emergency front of neck access scalpel cricothyroidotomy equipment. Endotracheal intubation may be indicated but not limited to maintaining a patent airway, facilitating oxygenation and ventilation, reducing the risk of aspiration, and assisting in the removal of secretions. Atotw 331 th rapid sequence induction 24 may 2016 page 1 of 8 g e n e r a l tutorial 331 key points rapid sequence induction rsi is intended to reduce the risk of aspiration by minimising the duration of an unprotected airway. Submental tracheal intubation was performed in cases needing. This technique should be included in airway workshops and courses. Submental intubationparamedian technique has been used in 15 cases from may 2005april 2007 in hosmat hospital, bangalore.
A modified submental approach for oral endotracheal intubation. Herein, we describe a refined technique based on altemirs original procedure. Orotracheal intubation was in maxillofacial surgery, general accomplished using a reinforced tracheal midline submental intubation anaesthesia is usually administered via the tube. All patients had fractures disturbing the dental occlusion plus either an associated fracture of the skull base or a displaced nasal fracture. Submental endotracheal intubation as an alternative to. 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. The potential indications for submental intubation extend beyond craniomaxillofacial trauma to include orthognathic surgery and elective craniomaxillofacial. Submental intubation combines retrogradq advantages of nasotracheal intubation, which allows the mobilization of the dental occlusion, and those of orotracheal intubation, which allows access to nasoorbitoethmoidal fractures caubi et al.
A useful alternative method of managing the airway intraoperatively is submental endotracheal intubation, where, the tube is passed through a submental skin incision into the mouth. The orotracheal intubation lateron under anaesthesia was converted to submental intubation. Submental intubation submental route of endotracheal intubation is a simple, safe and useful technique in maxillofacial trauma, where oral and nasal endotracheal intubation cannot be performed. Pdf acquisition of a secure airway is an essential element of the operative management of maxillofacial trauma. Rapporterede komplikationer i forbindelse med submental intubation. There were no complications relating to the submental intubation procedure. This method has now become widely established for airway management in adults with midfacial fractures especially when long term ventilation is not anticipated. Fig 1, 2 fig 1, submental intubation fig 2 submental intubation case 2. No consensus exists to date regarding the best method of controlling the airway for oral or. Pdf submental orotracheal intubation for maxillofacial. Hernandez altemir, a maxillofacial surgeon, first described an alternative for tracheostomy in 1986. Once files have been uploaded to our system, change the order of your pdf documents. After submental intubation wound after 48 hours discussion the submental intubation technique was found to be satisfactory for both the surgeon and anaesthesiologist.
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. Submental intubation technique for airway during surgery. Submental orotracheal intubation in maxillofacial surgery. Means of securing a patients airway other than the conventional oral intubation include nasotracheal intubation and surgical airways such as tracheostomy. Airway management in maxillofacial traumaalternative. Submental orotracheal intubationa technique for airway. Mar 30, 2012 submental intubation is an interesting alternative to tracheotomy, especially when short term postoperative control of airway is desirable with the presence of undisturbed access to oral as well as nasal airways and a good dental occlusion. Intubation is a form of invasive airway management whreby a artidficial airway is placed into a patients trachea 19. Submental intubation has been described as a safe and effective technique for intraoperative airway control for surgical fixation of complex panfacial fractures, as it avoids the risks and complications of na asotracheal intubation, and tr cheostomy 6. We would like to show you a description here but the site wont allow us. This method was recently implemented in the case of a patient with altered nasal anatomy who sustained a mandibular fracture necessitating. Submental intubation technique for airway during surgery of. Submental orotracheal intubation severe facial and anterior skull base trauma present particular challenges to the surgeon and anesthesiologist.
Submental tracheal intubation is a technique for use in patients with maxillofacial trauma. The purpose of this retrospective study was to evaluate the efficacy and complications of this technique compared with tracheostomy. 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. All these complications are comparatively rare and can be. In 1986, hernandez described submental intubation as an alternative to the classic methods 1. Submental intubation offers an alternative to this type of airway management. The escher of submental intubation is not as significant as that of tracheotomy and is tolerable by patients 3. Seven male patients with panfacial fractures underwent submental intubation. Midline submental intubation might be the preferred. Facial fractures and submental tracheal intubation m. Mar 27, 2018 the team did a submental intubation that is access to the airway or the windpipe by cutting under the chin and pulling the anesthetic tube through the submental or the chin region.
Submental approach to oroendotracheal intubation using a. Submental intubation with midline incision has been used in ten cases. Submental approach for oral endotracheal intubation in. Submental intubation in maxillofacial trauma patients. Submental endotracheal intubation is a simple, useful and safe technique in maxillofacial trauma when oral and nasal endotracheal intubation cannot be performed. Standardized procedure endotracheal intubatioin adults.
Following the submental intubation, the definitive surgery started. It avoids retromolar intubation tracheostomy and its disadvantages. 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. After mishap, patient had nasal bleed and loss of consciousness for 78 hours. Once you merge pdfs, you can send them directly to your email or download the file to our computer and view. It allowed uninterrupted surgical access and a secure airway. This leaves the facial bones, mandible, and skull base untouched. Submental intubation permitted reduction and fixation of all the fractures without the interference of the tube during surgical procedure in all of the patients. Report of two cases introduction maxillofacial trauma is a serious injury, which affect upper respiratory tract and cause structural defects. Submental intubation steps of the procedure explained 1.
This procedure avoids the use of tracheostomy and bypasses its associated morbidities. We conclude that the lmafastrach tm ett is a suitable device for submental intubation. Doctors conduct submental intubation in maxillofacial trauma. Despite the widespread use of submental intubation for other purposes, it was bogi and incze in 1996 who recommended the use of submental intubation in elective osteotomies. Twentyfive patients underwent submental tracheal intubation since 2001. This study was conducted with the aim to evaluate the frequency, indications, and outcomes of airway management by. Since that time, several case studies have been performed demonstrating the efficacy of the submental approach. Complications of submental intubation could include damage to the cuff balloon, infection of submental wound, abscess formation in the floor of the mouth, salivary fistula, development of mucocele, and hypertrophic scarring. This provides a secure airway and allows unimpeded surgical access to.
The operative procedure, in which the multiple fractures were reduced and fixated, proceeded. In comparing submental intubation and tracheostomy, submental intubation has no. Submental orotracheal intubation in maxillofacial fracture. Case report a 26 year old, 47 kg male met with a road traffic accident and was referred to our institute from private hospital. It is safe an effective option for pan fasciomaxillary trauma. No major complications associated with submental intubation have been reported, and none of the studies demonstrated hypoxia during disconnection of the ett. In 1986, hernandez altemir first reported submental intubation as a procedure to avoid tracheotomy in cases with open reduction of facial fractures to obtain intraoperative access to dental occlusions when either nasotracheal or orotracheal intubation is impossible. Technique after a standard orotracheal intubation, a temporary draping of the mouth and chin was carried out. This report describes our procedure including some technical modifications and caveats. Submental intubation combines retrogradq advantages of nasotracheal intubation, which allows the mobilization of the dental occlusion, and those of orotracheal intubation, which allows access to. Submental intubation europe pmc article europe pmc. Submental orotracheal intubation in maxillofacial fracture surgery. This is especially important in the surgical repair of complex maxillofacial traumas, where evaluation and establishment. In either situation, the oral incision is easily closed utilizing 33 plain gut sutures.
Surgical skin preparation of the the armoured tube is. Submental intubation provides access to all facial, pharyngeal, and skull base structures without interference of an endotracheal or nasotracheal tube. Skin closure is performed with the aid of local anesthetics submental endotracheal intubation 345 fig. Minor complications occurred in merely 7% of patients.
Data were collected from patients records for age, gender, mode of injury, type of maxillofacial trauma, associated trauma, intraoperative and postoperative complications regarding submental intubation. Submental intubation for a midface odontogenic tumor. Submental intubation allows intraoperative dental occlusion and is an acceptable option, especially when longterm postoperative ventilation is not planned. In contrast, the submental route for endotracheal intubation represents a fast and lowmorbidity alternative to tracheostomy. Pdf efficacy and complications of submental tracheal. The management of a difficult airway is one of the biggest challenges of perioperative anesthesia management. Mar 19, 2018 it is safe an effective option for pan fasciomaxillary trauma. Submental intubation should be considered as an option for airway management in selected cases of craniomaxillofacial surgery. Pdf submental endotracheal intubation cassiano pereira. Submental intubation in patients with complex maxillofacial injuries. Intubation, submental intubation to fixation of submental tube. Submental endotracheal intubation in concurrent orthognathic.
Submental intubation steps of the procedure explained. Submental intubation with lmafastrachtm endotracheal tube. In this case report, we described our experience with submental intubation using an lmafastrach tm endotracheal tube ett to facilitate the surgical fixation of bilateral le fort ii fractures. A variety of methods have been described for airway management in cases of panfacial trauma.
Preparation and planning including technique, medications, team member. It prevents need for tracheostomy and its consequent morbidity. Intraoperative view of the completed submental intubation as tube is fixed at the submental area with suture discussion the technique of submental intubation was introduced by altemir in 1986 altemir, 1986. Fiberoptic assisted submental endotracheal intubation a. Alternately, if the anes thetist so desires, the patient may be extubat ed through the submental incision and rein tubated with a standard oral tube.
A simple and reliable submental intubation technique for max. The submental intubation isan alternative route for nasal or oral intubation, especially in table 1. In comparing submental intubation and tracheostomy, submental intubation has no significant reported major complications jundt et al. Thus, submental intubation is a simple, safe, with low morbidity technique for operative. Case report the patient was a 23yearold male weighing 72 kg who was admitted to the accident and emergency department of imam khomeini hospital sari, iran. Submental orotracheal intubation for maxillofacial surgery.
Submandibular intubation is a modification of submental intubation first introduced by spanish maxillofacial surgeon altemir 3, 4 which was. Submental intubation was performed 45 times on 45 patients. On admission patient was conscious, with a glasgow coma score. Forum facial fractures and submental tracheal intubation. St george sutherland hospitals and health services. 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. A flexible and kinkresistant reinforced endotracheal tube. Submental intubation in oral and maxillofacial surgery a. Icu nursing practice committee, j cosgrove february 2014 page 3 of 20. A journey over the last 25 years article pdf available in journal of anaesthesiology clinical pharmacology 283. Abstractsubmental intubation is a method for airway without trachiotomy. This procedure consists of exteriorizing an oral endotracheal tube through the floor of the mouth and submental.
This relatively is a scarless procedure with minimum risk. Either a nasal or oral tube would have been in the way of the surgical field. Of the options available, submental intubation is an alternative to tracheostomy. Material and methods from july 2003 to february 2005, patients benefited from submental intubation table 1.
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