Submental Approach for Tracheal Intubation - An Alternative to Short-Term Tracheostomy in Patients with Panfacial Fractures: A Case Report

  • Aboo Abdul Rahiman Ramzi Manipal University,
Keywords: Difficult Airway, panfacial fractures, submental endotracheal intubation

Abstract

Intubating a patient with panfacial fractures is always a challenge to the anesthesiologist as both the anesthesiologist and the surgeon are essentially competing for the same space. The anesthetic management of a 19-year-old boy who presented with multiple maxillofacial injuries, pneumocephalus, and cerebral edema sustained during a road traffic accident has been described. He was posted for open reduction and internal fixation of the fractures, frontal sinus fracture elevation and basal repair which required access to scalp, mouth and the nose. As all the conventional modalities to secure airway seemed unsuitable, orotracheal intubation was done via submental route. Following intravenous induction the patient was intubated with a cuffed oral flexometallic tracheal tube. This was then modified to the submental route through a submental incision. The surgery proceeded uneventfully and the patient was extubated a day later in the ICU. He made a satisfactory recovery and the submental scar healed without complication or scarring. We briefly review the technique of submental intubation in adults which serves as an excellent alternative to tracheostomy.

Author Biography

Aboo Abdul Rahiman Ramzi, Manipal University,
Department of Anesthesiology

References

M S Premalatha, K Y Santosh, U Madhusudan. Submental Intubation in Patients with Panfacial Fractures: A Prospective Study. Indian Journal Of Anaesthesia 2011;55 (3): 299-304

G Uma, P N Viswanathan, P S Nagaraja. Submandibular Approach for Tracheal Intubation – A Case Report. Indian Journal Of Anaesthesia 2009; 53 (1):84-87

V Saraswat. Airway Management in Maxillofacial Trauma: A Retrospective Review of 127 Cases. Indian Journal Of Anaesthesia 2008; 52 (3):311-31

S M Saheb, V N Nath, K P Kumar, P P G Padmaja .A Novel Method Using Seldinger’s Technique For Submental Intubation In Major Craniomaxillofacial Fractures: A Case Series. Indian Journal Of Anaesthesia 2014;58(1):48-50

Hernández Altemir F. The Submental Route for Endotracheal Intubation. J Maxillofac Surg 1986; 14:64-65.

A Chandu, A C H Smith, R Gebert. Submental Intubation- An Alternative To Short Term Tracheostomy.Anaesth Intensive Care 2000; 28: 193-5

Kim KJ, Lee JS, Kim HJ, Ha JY, Park H, Han DW. Submental intubation with reinforced tube for intubating laryngeal mask airway.Yonsei medical journal. 2005 Aug 31; 46(4):571-4.

M Naveen, B Neerja, P Chari. Submental Endotracheal Intubation: A Useful Alternative to Tracheostomy. Indian J. Anaesth. 2002; 46 (5) : 400-2

Cipriano A, Mao ML, Hon HH, Vazquez D, Stawicki SP, Sharpe RP, Evans DC. An overview of complications associated with open and percutaneous tracheostomy procedures. International journal of critical illness and injury science. 2015 Jul;5(3):179.

D Pierre, G Michel, P Jean, G Yvan. Facilitating Submental Endotracheal Intubation with an Endotracheal Tube Exchanger. AnesthAnalg 2000; 90:222–3

Eisemann B, Eisemann M, Rizvi M, Urata MM, Lypka MA. Defining the role for submental intubation. Journal of clinical anesthesia. 2014 May 31; 26(3):238-42.

Published
2017-04-23
How to Cite
1.
Ramzi AAR. Submental Approach for Tracheal Intubation - An Alternative to Short-Term Tracheostomy in Patients with Panfacial Fractures: A Case Report. AACC. 3(2):334-6.
Section
Case Report(s)