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Submental intubation: alternative short-term airway management in maxillofacial trauma.

Kumar RR, Vyloppilli S, Sayd S, Thangavelu A, Joseph B, Ahsan A - J Korean Assoc Oral Maxillofac Surg (2016)

Bottom Line: In all 17 cases, the technique of submental intubation was found to be simple and reliable.Hypertrophic scars were noted in three cases, orocutaneous fistula and mucocele in one case each.All these complications were managed comfortably without significant morbidity to the patient.

View Article: PubMed Central - PubMed

Affiliation: Department of Oral and Maxillofacial Surgery, St. Joseph Dental College, Eluru, India.

ABSTRACT

Objectives: To assess submental route intubation as an alternative technique to a tracheostomy in the management of the airway in cranio-maxillofacial trauma, along with an assessment of its morbidity and complications.

Materials and methods: Submental intubation was performed in 17 patients who had maxillofacial panfacial trauma and management was done under general anesthesia during a period of one year from 2013 to 2014 at Departments of Oral and Maxillofacial Surgery and Dentistry, the Malankara Orthodox Syrian Church Medical College, Kochi, India.

Results: In all 17 cases, the technique of submental intubation was found to be simple and reliable. Hypertrophic scars were noted in three cases, orocutaneous fistula and mucocele in one case each. All these complications were managed comfortably without significant morbidity to the patient.

Conclusion: Submental intubation is a good technique that can be used regularly in the management of the airway in cranio-maxillofacial trauma, but with some manageable complications.

No MeSH data available.


Related in: MedlinePlus

Grasping endotracheal tube and pulling it out through the submental region.
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Figure 5: Grasping endotracheal tube and pulling it out through the submental region.

Mentions: All subjects underwent orotracheal intubation by standard direct laryngoscopy after induction of general anesthesia with a reinforced cuffed flexo-metallic tube. Orotracheal intubation was then converted to submental endotracheal intubation using the following procedure. Briefly, the skin of the perioral and submental regions was prepared using betadine and alcohol. A transverse 1-cm incision was made, bisecting the midline of the face in the submental crease below the lower border of the mandible.(Fig. 1, 2) The mouth was opened, and the tongue was elevated in a superoposterior direction with a towel clip. A 1-cm midline mucosal incision was made midway between the point of reflection of the mucosa from the mandible to the floor of the mouth and the submandibular ductal papillae.(Fig. 3) The incision was then deepened inferiorly between the geniohyoid, genioglossus, and the anterior bellies of the digastric muscles. A large curved hemostat was placed through the submental incision, and the pilot tube connector was grasped and pulled through the incision.(Fig. 4, 5) The connector on the endotracheal tube was removed and then exteriorized via the submental incision. After confirmation of its adequate tracheal position by capnography and bilateral auscultation of the lungs, the tube was reconnected and secured to the skin with 1-0 silk sutures.(Fig. 6) The tube was positioned intraorally between the mandible and the tongue just above the mucosa of the floor of the mouth.


Submental intubation: alternative short-term airway management in maxillofacial trauma.

Kumar RR, Vyloppilli S, Sayd S, Thangavelu A, Joseph B, Ahsan A - J Korean Assoc Oral Maxillofac Surg (2016)

Grasping endotracheal tube and pulling it out through the submental region.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4940200&req=5

Figure 5: Grasping endotracheal tube and pulling it out through the submental region.
Mentions: All subjects underwent orotracheal intubation by standard direct laryngoscopy after induction of general anesthesia with a reinforced cuffed flexo-metallic tube. Orotracheal intubation was then converted to submental endotracheal intubation using the following procedure. Briefly, the skin of the perioral and submental regions was prepared using betadine and alcohol. A transverse 1-cm incision was made, bisecting the midline of the face in the submental crease below the lower border of the mandible.(Fig. 1, 2) The mouth was opened, and the tongue was elevated in a superoposterior direction with a towel clip. A 1-cm midline mucosal incision was made midway between the point of reflection of the mucosa from the mandible to the floor of the mouth and the submandibular ductal papillae.(Fig. 3) The incision was then deepened inferiorly between the geniohyoid, genioglossus, and the anterior bellies of the digastric muscles. A large curved hemostat was placed through the submental incision, and the pilot tube connector was grasped and pulled through the incision.(Fig. 4, 5) The connector on the endotracheal tube was removed and then exteriorized via the submental incision. After confirmation of its adequate tracheal position by capnography and bilateral auscultation of the lungs, the tube was reconnected and secured to the skin with 1-0 silk sutures.(Fig. 6) The tube was positioned intraorally between the mandible and the tongue just above the mucosa of the floor of the mouth.

Bottom Line: In all 17 cases, the technique of submental intubation was found to be simple and reliable.Hypertrophic scars were noted in three cases, orocutaneous fistula and mucocele in one case each.All these complications were managed comfortably without significant morbidity to the patient.

View Article: PubMed Central - PubMed

Affiliation: Department of Oral and Maxillofacial Surgery, St. Joseph Dental College, Eluru, India.

ABSTRACT

Objectives: To assess submental route intubation as an alternative technique to a tracheostomy in the management of the airway in cranio-maxillofacial trauma, along with an assessment of its morbidity and complications.

Materials and methods: Submental intubation was performed in 17 patients who had maxillofacial panfacial trauma and management was done under general anesthesia during a period of one year from 2013 to 2014 at Departments of Oral and Maxillofacial Surgery and Dentistry, the Malankara Orthodox Syrian Church Medical College, Kochi, India.

Results: In all 17 cases, the technique of submental intubation was found to be simple and reliable. Hypertrophic scars were noted in three cases, orocutaneous fistula and mucocele in one case each. All these complications were managed comfortably without significant morbidity to the patient.

Conclusion: Submental intubation is a good technique that can be used regularly in the management of the airway in cranio-maxillofacial trauma, but with some manageable complications.

No MeSH data available.


Related in: MedlinePlus