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