Transmylohyoid/Submental intubation: review, analysis, and refinements

Area of Science:

• Maxillofacial Surgery
• Anesthesiology
• Surgical Airway Management

Background:

• Managing patients with facial polytrauma or complex osteotomies presents airway challenges for surgeons and anesthesiologists.
• The submental route for endotracheal intubation was first described by Hernandez in 1986 to avoid tracheotomy in maxillofacial trauma.
• Tracheotomy is often considered in cases requiring short-term maxillomandibular fixation.

Purpose of the Study:

• To present a 20-year experience using transmylohyoid intubation.
• To critically analyze the problems and complications associated with this technique.
• To offer suggestions and refinements for improved airway management in complex maxillofacial cases.

Main Methods:

• Utilizing the transmylohyoid (submental) route for endotracheal intubation.
• Application of the technique in patients undergoing complex maxillofacial procedures and trauma management.
• Review of 400 cases where tracheostomy was successfully avoided.

Main Results:

• Successfully avoided tracheostomy in 400 patients over 20 years.
• Demonstrated the efficacy of transmylohyoid intubation in challenging surgical scenarios.
• Identified and analyzed specific problems and complications encountered.

Conclusions:

• Transmylohyoid intubation is a viable and effective alternative to tracheostomy in select maxillofacial surgery patients.
• The technique facilitates unobstructed surgical access in complex facial trauma and osteotomies.
• Continued refinement of the transmylohyoid intubation technique can enhance patient outcomes and safety.