Indian Journal of Public Health Research & Development

Open Access Open Access  Restricted Access Subscription Access
Open Access Open Access Open Access  Restricted Access Restricted Access Subscription Access

Intubation in Maxillofacial Trauma - a Dilemma


Affiliations
1 Department of Oral and Maxillofacial Surgery D J College of Dental Sciences and Research Modinagar, India
2 Department of Oral and Maxillofacial Surgery MCODS Manipal, India
     

   Subscribe/Renew Journal


Complex midfacial or panfacial injuries often require tracheostomy to ensure a free operative field. Oral intubation can interfere with assessment of occlusion and nasal tracheal intubation may lead to complications (brain damage, leakage of cerebrospinal fluid, and meningitis) when there are also fractures of the base of the skull. On the other hand, tracheostomy is associated with complications such as haemorrhage, pneumomediastinum or pneumothorax, injury to the recurrent laryngeal nerve, and tracheal stenosis and should be reserved for severely injured patients who need protracted assistance with ventilation or further operations. A useful alternative method of managing the airway intraoperatively are by submental endotracheal intubation and retromolar intubation. Submental intubation allows tracheal intubation by passing the tube through a submental skin incision into the mouth. Retromolar intubation is a non-invasive technique and avoids both submental tracheal intubation and tracheostomy in the majority of patients.In this paper two cases of maxillofacial injury, operated one using submental technique and another with retromolar intubation are reported.

Keywords

Submental Intubation, Retromolar Intubation, Maxillofacial Trauma, Anesthetic Techniques, Inter Maxillary Fixation
Subscription Login to verify subscription
User
Notifications
Font Size


  • Taicher S, Givol N, Peleg M, Ardekian L: Changing indications for tracheostomy in maxillofacial trauma. J Oral Maxillofac Surg 1996, 54: 292–295.

  • Martinez-Lage JL, Eslara JM, Cebrecos AI, Marcos O: Retromolar intubation. J Oral Maxillofac Surg 1968; 56: 302–306.

  • Johnson TR: Submental tracheal intubation versus tracheostomy.Br J Anaesth 2000; 89: 344–345.

  • Manganello-Souza LC, Tenorio-Cabezas N, Piccinini L: Submental method for orotracheal intubation in treating facial trauma. Rev Paul Med 1998; 116: 1829–1832.

  • Amin M, Dill-Russel P, Manisali M, Lee R, Sinton I: Facial fractures and submental tracheal intubation. Anaesthesia 2003; 58: 496–497.

  • Meyer C, Valfrey J, Kjartansdottir T, Wilk A, Barriere P: J Cranio- Maxillofac Surg 2003; 31: 383–388.

  • Martinez lage JL eslava JM, Cerbrecos AL retromolar intubation, J Oral and Maxfac Surg 1998; 56: 302.

  • Marlow TJ ,Gotra DD,Schabel SI. Intracranial placement of a nasotracheal tube after facial fracture: a rare complication, J Emerg med 1997; 15: 187.

  • Hernández Altemir F: The submental route for endotracheal intubation. A new technique. J Maxillofac Surg 1986; 14:64.

  • Stoll P, Galli C,Wachter R, BahrW: Submandibular endotracheal intubation in panfacial fractures. J Clin Anesth 1994; 6:83–86.

  • Petr Schütz, MD,and Hussein H. Hamed,: Submental Intubation Versus Tracheostomy in Maxillofacial Trauma Patients. J Oral Maxillofac Surg 2008; 66:1404-1409.

  • Hernández Altemir F and Montero H: The submental route revisited using the laryngeal mask airway: a technical note. Journal of craniomaxillofacial surgery 2000; 28:343-344.

  • Taglialatela Scafati C, Maio G, Aliberti F: Submentosubmandibular intubation: Is the subperiosteal passage essential? Experience in 107 consecutive cases. Br J Oral Maxillofac Surg 2006; 44:12.

  • Green JD, Moore UJ: A modification of submental intubation. Br J Anaesth 1996; 77:789.

  • MacInnis E, Baig M: A modified submental approach for oral endotracheal intubation. Int J Oral Maxillofac Surg 1999; 28:344.

  • Cova M, Ukmar M, Bole T: Evaluation of lingual vascular canals of the mandible with computed tomography. Radiol Med (Torino) 2003; 106:391.

  • Schutz P and Hameed HH. Submental versus tracheostomy, J oral anf maxfac surg. 2008; 66,1404-1409

  • Martinez lage JL eslava JM, Cerbrecos AL retromolar intubation, J Oral and Maxfac Surg 1998; 56:302.


Abstract Views: 255

PDF Views: 0




  • Intubation in Maxillofacial Trauma - a Dilemma

Abstract Views: 255  |  PDF Views: 0

Authors

B. Vidya
Department of Oral and Maxillofacial Surgery D J College of Dental Sciences and Research Modinagar, India
K. M. Cariappa
Department of Oral and Maxillofacial Surgery MCODS Manipal, India
T. Abhay Kamath
Department of Oral and Maxillofacial Surgery MCODS Manipal, India

Abstract


Complex midfacial or panfacial injuries often require tracheostomy to ensure a free operative field. Oral intubation can interfere with assessment of occlusion and nasal tracheal intubation may lead to complications (brain damage, leakage of cerebrospinal fluid, and meningitis) when there are also fractures of the base of the skull. On the other hand, tracheostomy is associated with complications such as haemorrhage, pneumomediastinum or pneumothorax, injury to the recurrent laryngeal nerve, and tracheal stenosis and should be reserved for severely injured patients who need protracted assistance with ventilation or further operations. A useful alternative method of managing the airway intraoperatively are by submental endotracheal intubation and retromolar intubation. Submental intubation allows tracheal intubation by passing the tube through a submental skin incision into the mouth. Retromolar intubation is a non-invasive technique and avoids both submental tracheal intubation and tracheostomy in the majority of patients.In this paper two cases of maxillofacial injury, operated one using submental technique and another with retromolar intubation are reported.

Keywords


Submental Intubation, Retromolar Intubation, Maxillofacial Trauma, Anesthetic Techniques, Inter Maxillary Fixation

References