Submental intubation in patients with midfacial fractures

A Submental endotracheal intubation technique is an alternative to nasoendotracheal intubation and tracheostomy in the management of patients with severe midfacial fractures. The procedure is simple to perform and has a low morbidity.

Surgical intubation in maxillofacial surgery is usually undertaken with nasoendotracheal intubation. With this method, problems arise when fractures of the midfacial region are to be operated, which might result in complications like epitaxis, trauma to the pharynx, pressure necrosis of the external nares, sinusitis, inability to pass the tube through nasal passages, and forcing of small bone fragments into the tube. In these cases, the anesthetist prefers to intubate through oral route. This is a disadvantage for oral surgeons as it interferes with bringing the teeth into occlusion.

In this case, the submental approach for intubation allows an unimpeded manipulation of the midfacial fractures and ease in checking occlusion. There are four main advantages of this technique :

  • voids complications of nasoendotracheal intubation for airway management of patients with severe midfacial fractures.
  • Simple procedure with low morbidity, such as infection and oro-cutaneous fistula.
  • Does not interfere with intraoral surgical manipulations and maxillo-mandibular fixation.
  • Can be used in patients undergoing elective maxillary orthognathic surgery in the presence of nasal obstructions, and cleft lip and palate patients.



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