Clinical Outcomes of Submental Intubation versus Tracheostomy and Nasotracheal Intubation in the Management of Difficult Airways Due to Maxillofacial Trauma

Abstract

Background: Airway management in panfacial fractures presents a challenge, as standard oral intubation often precludes surgical fixation. This study evaluated and compared the clinical outcomes of three alternative modalities: submental intubation, tracheostomy, and general anesthesia nasotracheal intubation (GANI).
Methods: A prospective cohort study was conducted at Wahidin Sudirohusodo Hospital, Makassar, Indonesia, from August 2024 to January 2025. Forty patients with complex maxillofacial trauma requiring alternative airway management were included. The primary outcomes measured were procedural duration, length of stay (LOS), and complication rates. Statistical analysis was performed using Kruskal-Wallis and Mann-Whitney U tests.
Results: The cohort was predominantly male (62.5%) with a mean age of 24.78 years. Submental intubation was the most utilized technique (57.5%), followed by GANI (30%) and tracheostomy (12.5%). No complications were recorded across groups (0%). There was a significant difference in procedural duration (p=0.004); tracheostomy was the fastest (mean 7.00 min), followed by GANI (8.75 min) and submental intubation (12.83 min). However, tracheostomy was associated with a significantly prolonged LOS (16.40 days) compared to submental intubation (7.48 days) and GANI (7.50 days) (p=0.008). No significant difference in LOS was found between the submental and GANI groups.
Conclusion: The procedure has the shortest duration, but may prolong hospitalization and increase the cost of healthcare. Submental intubation is a safe and effective alternative which allows surgical accessibility and provides a similar post-intubation recovery time to nasotracheal, while eliminating the need for tracheostomy in selected complex trauma cases.