Submental intubation for maxillomandibular advancement improves short-term nasal breathing outcomes

The purpose of this study was to determine if submental intubation during maxillomandibular advancement (MMA) reduces the development of nasal obstruction in patients with obstructive sleep apnea (OSA).

This study was a prospective, single cohort of consecutive adult patients undergoing MMA surgery for OSA at a single institution. The primary outcome measure was the development of nasal obstruction using the Nasal Obstruction Symptom Evaluation scale. Secondary outcomes included the rate of reintubation, submandibular duct function, development of neck infection, the need for subsequent surgical correction of nasal obstruction, and changes in the Apnea-Hypopnea Index.

Twenty consecutive patients (85% male, mean age 47 years) were included in the study. Nasal Obstruction Symptom Evaluation scores improved in 88% of patients, with a mean improvement from 46.6 ± 28.9 to 15.9 ± 20.9 at 3 months (P < .01). No participant required reintubation, and all patients had adequate bilateral submandibular gland function at follow-up. The mean Apnea-Hypopnea Index improved from 58.1 ± 32.0 to 8.3 ± 4.7 (P < .01).

Submental intubation for patients undergoing MMA for OSA appears to be a well-tolerated, expeditious alternative to nasal intubation with excellent nasal breathing results. Larger, prospective investigations to confirm these findings should be considered.