Submental intubation as an alternative to tracheostomy in complex panfacial fracture: a case report

Submental intubation, first described in 1986, is an effective alternative to tracheostomy in patients with complex facial fractures in whom nasotracheal intubation is contraindicated and orotracheal intubation would interfere with the surgical field. We report the case of a 38-year-old man with a history of morbid obesity who suffered a panfacial fracture with involvement of the frontal sinuses and intracranial communication after falling from a second floor. Nasotracheal intubation was contraindicated, and orotracheal intubation would have interfered with the planned intermaxillary fixation. We first performed fibreoptic orotracheal intubation, which was then surgically converted to submental intubation. No intraoperative or postoperative complications occurred, and the patient's evolution was favourable, with only minimal scarring in the submental region. Recent literature has confirmed that this technique is safe and is associated with less morbidity and better aesthetic outcomes than tracheostomy. This case highlights the need to consider submental intubation as a priority airway management option in complex panfacial fractures.