Authors:

Abstract

Complex maxillofacial surgeries have always been a challenge for anaesthesiologists, where oral cavity is the main field of surgery and dental occlusion is a prerequisite. In such conditions, anaesthesiologists opt for nasotracheal intubation. Some patients however may require simultaneous free nasal field where nasal fracture and cerebrospinal fluid leak may contraindicate nasotracheal intubation. Tracheostomy has long been the sole answer to these problems. Here submental approach for tracheal intubation can be an apt alternative.

In this approach the endotracheal tube is introduced along a diverted route through the floor of mouth via a tunnel made in the submental region. We opted for this technique in four patients posted for fixing facial bones, requiring both nasal and oral fields and the results have been satisfying. In two patients we used one tube method. In the other two patients, we used double tube method where another tube was brought intraoral through submental incision and the first tube was replaced.

This technique avoided the need for tracheostomy and provided a safe airway without causing significant morbidity. Thus submental approach for tracheal intubtion can be a better solution to various problems arising in cases of complex maxillofacial surgeries. We also found that double tube method was safer and even easier than one tube method for submental  intubation.

DOI: http://dx.doi.org/10.4038/slja.v20i2.3524

Sri Lankan Journal of Anaesthesiology.2012:20(2);100-103

Keywords: submental route, maxillo facial surgery, intubation