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

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.