[Intraoral dental fixation of an endotracheal tube using a cofferdam clamp]

Extraoral tape fixation of the orotracheal tube for general anesthesia is a major problem in maxillofacial surgery. First of all, surgical access to the perioral and nasal region is handicapped by the tape covering and distracting the skin, especially in those cases where no nasotracheal intubation is possible; furthermore, blood, saliva, and disinfectant fluid interfere with reliable adhesion of the tape. A method of intraoral dental fixation of the orotracheal tube by a rubber dam fixation clamp is presented. The rubber dam isolates teeth against the oral cavity, providing a dry operative field to the dentist. The set of clamps, each designed according to the individual anatomy of the different teeth, is usual in the dental trade. After intubation the selected clamp is placed on the tooth by means of the forceps. The tube is laid on the clamp and tied on by a silk thread (2 x 0), which is inserted through the clamp's holes. We recommend fixation to the teeth in the mandible to avoid tension load, which could strain teeth in the maxilla; as far as possible only teeth without any impairment (e.g. loosening) should be selected.

The method of intraoral dental fixation of the orotracheal tube by a rubber dam clamp offers the following advantages: (1) the surgeon, especially the maxillofacial surgeon, has a good view of the perioral region and free access for surgery; there is (2) no skin distraction or irritation by tape; there is (3) reliable tube fixation even for patients with allergy to adhesive materials; there is (4) no solution of tape fixation by blood, saliva, or disinfectant fluid; and (5) silk sutures cannot be subjected to strain when solving tape fixation.