The submental incision healed with minimal scarring. This study was conducted with the aim to evaluate the frequency, indications, and outcomes of airway management by. Submental intubation permitted reduction and fixation of all the fractures without the interference of the tube during surgical procedure in all of the patients. This provides a secure airway and allows unimpeded surgical access to. In comparing submental intubation and tracheostomy, submental intubation has no significant reported major complications jundt et al. Fig 1, 2 fig 1, submental intubation fig 2 submental intubation case 2. Submental orotracheal intubation in maxillofacial fracture surgery. 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. A variety of methods have been described for airway management in cases of panfacial trauma. A journey over the last 25 years article pdf available in journal of anaesthesiology clinical pharmacology 283. The orotracheal intubation lateron under anaesthesia was converted to submental intubation.
Submental orotracheal intubation in maxillofacial surgery. Standardized procedure endotracheal intubatioin adults. Preparation and planning including technique, medications, team member. Panfacial fractures or concomitant nasoethmoidal injuries. After submental intubation wound after 48 hours discussion the submental intubation technique was found to be satisfactory for both the surgeon and anaesthesiologist. Seven male patients with panfacial fractures underwent submental intubation. The resultant situation disturbs the ease of surgical and anaesthetic procedures and jeopardizes airway patency. This is especially important in the surgical repair of complex maxillofacial traumas, where evaluation and establishment.
Material and methods from july 2003 to february 2005, patients benefited from submental intubation table 1. Submental orotracheal intubationa technique for airway. Intubation is a form of invasive airway management whreby a artidficial airway is placed into a patients trachea 19. Nov, 2012 hernandez first described the submental route for endotracheal intubation in 1986 as an alternative airway maneuver for maxillofacial procedures. This technique should be included in airway workshops and courses.
This paper reports a case of maxillofacial injury, operated using submental intubation technique. Submental intubation for a midface odontogenic tumor. There are technical problems with the original technique described. A simple and reliable submental intubation technique for. Submental endotracheal intubation in concurrent orthognathic. A simple and reliable submental intubation technique for max. Submental orotracheal intubation severe facial and anterior skull base trauma present particular challenges to the surgeon and anesthesiologist. 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. Fiberoptic assisted submental endotracheal intubation a. 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 submental route of endotracheal intubation is a simple, safe and useful technique in maxillofacial trauma, where oral and nasal endotracheal intubation cannot be performed. 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 submental intubation isan alternative route for nasal or oral intubation, especially in table 1. 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. A flexible and kinkresistant reinforced endotracheal tube. St george sutherland hospitals and health services. Submental intubation with lmafastrach endotracheal tube. Submental intubation or its modification as retrograde submental intubation was first described in a patient with restricted mouth opening by arya et al. Pdf submental orotracheal intubation for maxillofacial.
Submental intubation is a simple, quick and effective alternative to oral and nasal intubation or tracheostomy. An alternative for tracheostomy was first described by hernandez altemir in 1986. Submental tracheal intubation was performed in cases needing. Report of two cases introduction maxillofacial trauma is a serious injury, which affect upper respiratory tract and cause structural defects. Sep 25, 2015 submental intubation steps of the procedure explained 1. Either a nasal or oral tube would have been in the way of the surgical field. On admission patient was conscious, with a glasgow coma score. 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. Doctors conduct submental intubation in maxillofacial trauma.
Orotracheal intubation was in maxillofacial surgery, general accomplished using a reinforced tracheal midline submental intubation anaesthesia is usually administered via the tube. In patients who require intubation for maxillofacial. This technique involves passing an endotracheal tube through the anterior floor of the mouth, and then down the airway. A modified submental approach for oral endotracheal intubation. Abstractsubmental intubation is a method for airway without trachiotomy. Submental orotracheal intubation in maxillofacial fracture. Intubation, submental intubation to fixation of submental tube. Submental intubation was performed 45 times on 45 patients. Thus, submental intubation is a simple, safe, with low morbidity technique for operative. Of the options available, submental intubation is an alternative to tracheostomy. Submental intubation offers an alternative to this type of airway management, involving a decreased risk for the patient due. Submental intubationparamedian technique has been used in 15 cases from may 2005april 2007 in hosmat hospital, bangalore.
No major complications associated with submental intubation have been reported, and none of the studies demonstrated hypoxia during disconnection of the ett. Anesthesiology january april 2000 left molar approach improves the view in difficult laryngoscopy. Submental intubation technique for airway during surgery of. 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.
Submental intubation as an alternative to tracheostomy in patients with midfacial trauma submental intubation is a safe procedure which can be used tabel 1. It provides added advantage of control of occlusion during the panfacial trauma management. Once files have been uploaded to our system, change the order of your pdf documents. Submental intubation in oral maxillofacial surgery. Some possible side effects of submental intubation include accidental ejection of the tube, sudden movement of the tube into the main bronchus, bleeding or hemorrhage, infection, and salivary gland and meatus trauma 7. This relatively is a scarless procedure with minimum risk. This procedure consists of exteriorizing an oral endotracheal tube through the floor of the mouth and submental.
When neither nasotracheal nor orotracheal intubation is suitable, submental intubation is a suitable alternative to the. The potential indications for submental intubation extend beyond craniomaxillofacial trauma to include orthognathic surgery and elective craniomaxillofacial. Submental intubation in patients with complex maxillofacial injuries. 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. Introduction management of airway is a significant issue in. Skin closure is performed with the aid of local anesthetics submental endotracheal intubation 345 fig. 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. Pdf submental endotracheal intubation cassiano pereira.
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. There were no complications relating to the submental intubation procedure. Submandibular intubation is a modification of submental intubation first introduced by spanish maxillofacial surgeon altemir 3, 4 which was. No consensus exists to date regarding the best method of controlling the airway for oral or.
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. Submental intubation provides access to all facial, pharyngeal, and skull base structures without interference of an endotracheal or nasotracheal tube. 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. Indications for submental intubation are maxillofacial injuries with associated fractures of nasal bone and skull base or use of temporary. Case report a 26 year old, 47 kg male met with a road traffic accident and was referred to our institute from private hospital. We conclude that the lmafastrach tm ett is a suitable device for submental intubation.
Submental intubation is an effective and less invasive alternative to tracheostomy during intraoperative airway management where orotracheal and nasotracheal intubation are not appropriate options. This method has now become widely established for airway management in adults with midfacial fractures especially when long term ventilation is not anticipated. Submental intubation steps of the procedure explained. 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. Minor complications occurred in merely 7% of patients. It avoids retromolar intubation tracheostomy and its disadvantages. Technique after a standard orotracheal intubation, a temporary draping of the mouth and chin was carried out. Icu nursing practice committee, j cosgrove february 2014 page 3 of 20.
Submental intubation provides intraoperative airway control, avoids use of oral and nasal route, with minimal complications. Submental intubation offers an alternative to this type of airway management. Submental intubation allows intraoperative dental occlusion and is an acceptable option, especially when longterm postoperative ventilation is not planned. Rearrange individual pages or entire files in the desired order. Submental intubation should be considered as an option for airway management in selected cases of craniomaxillofacial surgery. Submental intubation with midline incision has been used in ten cases.
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. 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. 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. All patients had fractures disturbing the dental occlusion plus either an associated fracture of the skull base or a displaced nasal fracture. In contrast, the submental route for endotracheal intubation represents a fast and lowmorbidity alternative to tracheostomy. The purpose of this retrospective study was to evaluate the efficacy and complications of this technique compared with tracheostomy. Submental intubation steps of the procedure explained 1. 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. Pdf merge combine pdf files free tool to merge pdf online. Twentyfive patients underwent submental tracheal intubation since 2001. 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.
The management of a difficult airway is one of the biggest challenges of perioperative anesthesia management. It allowed uninterrupted surgical access and a secure airway. Mar 19, 2018 it is safe an effective option for pan fasciomaxillary trauma. Emergency front of neck access scalpel cricothyroidotomy equipment. Facial fractures and submental tracheal intubation m.
After mishap, patient had nasal bleed and loss of consciousness for 78 hours. The escher of submental intubation is not as significant as that of tracheotomy and is tolerable by patients 3. This report describes our procedure including some technical modifications and caveats. Submental tracheal intubation is a technique for use in patients with maxillofacial trauma. Submental intubation in oral and maxillofacial surgery a. Submental intubation technique for airway during surgery.
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. In comparing submental intubation and tracheostomy, submental intubation has no. Submental intubation europe pmc article europe pmc. Pdf acquisition of a secure airway is an essential element of the operative management of maxillofacial trauma.
Submental endotracheal intubation as an alternative to. This leaves the facial bones, mandible, and skull base untouched. 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. Midline submental intubation might be the preferred. We would like to show you a description here but the site wont allow us. Tracheal intubation via the submental route was first described by altemir in 1986. Once you merge pdfs, you can send them directly to your email or download the file to our computer and view. Surgical skin preparation of the the armoured tube is. Forum facial fractures and submental tracheal intubation. Submental endotracheal intubation is a simple, useful and safe technique in maxillofacial trauma when oral and nasal endotracheal intubation cannot be performed. This method was recently implemented in the case of a patient with altered nasal anatomy who sustained a mandibular fracture necessitating. Airway management in maxillofacial traumaalternative. Rapporterede komplikationer i forbindelse med submental intubation.
Submental intubation in maxillofacial trauma patients. It is safe an effective option for pan fasciomaxillary trauma. The operative procedure, in which the multiple fractures were reduced and fixated, proceeded. Submental orotracheal intubation for maxillofacial surgery. Submental intubation is a simple, secure and effective procedure for operative airway control in major maxillofacial traumas. Herein, we describe a refined technique based on altemirs original procedure. 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. It prevents need for tracheostomy and its consequent morbidity. In either situation, the oral incision is easily closed utilizing 33 plain gut sutures. In 1986, hernandez described submental intubation as an alternative to the classic methods 1.
All these complications are comparatively rare and can be. Pdf efficacy and complications of submental tracheal. 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. A 40 year old male patient, reported to our casuality department who had met with a road traffic accident.
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