Submental intubation in complex craniomaxillofacial trauma

Area of Science:

• Oral and Maxillofacial Surgery
• Trauma Surgery
• Anesthesiology

Background:

• Complex craniomaxillofacial injuries often necessitate airway management strategies that balance surgical access with patient safety.
• Maxillomandibular fixation (MMF) is crucial for restoring dental occlusion in jaw fractures but complicates traditional intubation methods.
• Existing alternatives like nasotracheal intubation and tracheostomy have specific contraindications and potential complications.

Purpose of the Study:

• To evaluate the efficacy and safety of the submental route for endotracheal intubation in patients with craniomaxillofacial trauma.
• To describe the indications and technique for submental intubation in this patient population.
• To assess the morbidity associated with submental intubation compared to other airway management options.

Main Methods:

• Retrospective review of 11 cases utilizing submental intubation over a 3-year period.
• Analysis of patient selection criteria, focusing on those requiring intraoperative MMF and complex facial injuries.
• Detailed description of the submental intubation technique.

Main Results:

• Submental intubation was successfully employed in 11 selected patients out of 190 with craniomaxillofacial trauma.
• No significant complications were reported in the cases reviewed.
• The technique proved feasible and effective for airway management during MMF.

Conclusions:

• Submental intubation is a viable and low-morbidity technique for selected patients with complex craniomaxillofacial trauma.
• It provides a crucial airway solution when MMF precludes other intubation methods.
• This approach offers a safe alternative to tracheostomy when not otherwise indicated.