ABSTRACT
Background: oromaxillofacial surgical procedures present a unique set of problems both for
the surgeon and for the anesthesist. achieving dental occlusion is one of the fundamental
aims of most oromaxillofacial procedures. oral intubation precludes this surgical
prerequisite of checking dental occlusion. having the tube in the field of surgery
is often disturbing for the surgeon too, especially in the patient for whom skull
base surgery is planned. nasotracheal intubation is usually contraindicated in the
presence of nasal bone fractures seen either in isolation or as a component of le
fort fractures. we utilized submental endotracheal intubation in such situations and
the experience has been very satisfying.materials and methods: the technique has been used in 20 patients with maxillofacial injuries and those
requiring le fort i approach with or without maxillary swing for skull base tumors.
initial oral intubation is done with a flexo-metallic tube. a small 1.5 cm incision
is given in the submental region and a blunt tunnel is created in the floor of the
mouth staying close to the lingual surface of mandible and a small opening is made
in the mucosa. the tracheal end of tube is stabilized with magil′s forceps, and the
proximal end is brought out through submental incision by using a blunt hemostat taking
care not to injure the pilot balloon. at the end of procedure extubation is done through
submental location only.results: the technique of submental intubation was used in a series of twenty patients from
january 2005 to date. there were fifteen male patients and five female patients with
a mean age of twenty seven years (range 10 to 52). seven patients had le fort i osteotomy
as part of the approach for skull base surgery. twelve patients had midfacial fractures
at the le fort ii level, of which 8 patients in addition had naso-ethomoidal fractures
and 10 patients an associated fracture mandible. twelve patients were extubated in
the theatre. eight patients had delayed extubation in the post-operative ward between
1 and 3 days postoperatively.conclusion: in conclusion, the submental intubation technique has proved to be a simple solution
for many a difficult problem one would encounter during oromaxillofacial surgical
procedures. it provides a safe and reliable route for the endotracheal tube during
intubation while staying clear of the surgical field and permitting the checking of
the dental occlusion, all without causing any significant morbidity for the patient.
its usefulness both in the emergency setting and for elective procedures has been
proved. the simplicity of the technique with no specialized equipment or technical
expertise required makes it especially advantageous. this technique therefore, when
used in appropriate cases, allows both the surgeon and the anesthetist deliver a better
quality of patient care.
KEYWORDS
Avoiding tracheostomy - oromaxillofacial surgery - intubation
