[Management of panfacial fractures--also an intubation problem]

Conventional oro- or nasotracheal intubation represents an obstacle in cases of panfacial fractures or elective operations of the facial skeleton above the Le Fort I level because of the intermaxillary fixation that often becomes necessary. Until recently, protection of the airway required tracheotomy with its well-known disadvantages of the usual intubations, which could compromise surgical strategies. A useful alternative method for protecting the airway involves the submental route for intubation and was first described in 1986 by Altemir. We present our experience with submandibular transmylohoid intubation in 14 patients. The technique is relatively simple and includes only a small risk potential. The cosmetic result of the extraoral incision required is good to excellent.