Skip to main content

Advertisement

Log in

Transmylohoid/Submental Endotracheal Intubation in Pan-facial Trauma: A Paradigm Shift in Airway Management with Prospective Study of 35 Cases

  • Original Article
  • Published:
Indian Journal of Otolaryngology and Head & Neck Surgery Aims and scope Submit manuscript

Abstract

The present study was planned to assess the efficacy, utility and complications of transmylohoid intubation in facial polytrauma patients, by setting and design: prospective study. This study was conducted between May 2008 and May 2011 and 35 patients of facial polytrauma were included irrespective of sex, caste and religion. All the selected 35 patients were male and the age of patients ranged between 15 to 45 years (mean age 31 years). All the patients were intubated with transmylohoid, orotracheal intubation using an armoured endotracheal tube (ETT). Average time to perform transmylohoid intubation was 15.51 + 1.85 min (mean + standarad deviation). Average time for drawing the ETT transmylohoid from the submental incision was 49.7 + 24.8 s. Mean duration for which the ETT was kept indwelling was 0.37 + 1.03 days. Accidental extubation of ETT was noted in two patients. Minor post operative complications like swelling in the submental area (2 patient), dehiscence of the submental incision (2 patient) and minor infection at the site of submental incision (3 patients) were noticed, which were found to be statistically insignificant. The transmylohoid intubation allowed simultaneous reduction and fixation of all the facial fractures and intraoperative control of dental occlusion without interference from the tube during the surgery without interfering in the maintenance of the anesthesia and air way.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Caron G, Paquin R, Lessard MR et al (2000) Submental endotracheal intubation: an alternative to tracheotomy in patients with midfacial and panfacial fractures. J Trauma 48:235–240

    Article  PubMed  CAS  Google Scholar 

  2. Stranc Waldron J, Padgham ND, Hurley SE (1990) Complications of emergency and elective tracheostomy: a retrospective study of 150 consecutive cases. Ann R Coll Surg Engl 72:218–220

    Google Scholar 

  3. Muzzi DA, Losasso TJ, Cucchiara RF (1991) Complication from a nasopharyngeal airway in a patient with a basilar skull fracture. Anesthesiology 74:366–368

    Article  PubMed  CAS  Google Scholar 

  4. Hernandez Altemir F (1986) The submental route for endo-tracheal intubation. A new technique. J Cranio Maxillofac Surg 14:64–65

    Article  CAS  Google Scholar 

  5. MacInnis E, Baig M (1999) A modified submental approach for oral endotracheal intubation. Int J Oral Maxillofac Surg 28:344–346

    Article  PubMed  CAS  Google Scholar 

  6. Lim HK et al (2003) Modified submental orotracheal intubation using blue cap on the end of the thoracic catheter. Yonsei Med J 44(5):919–922

    PubMed  Google Scholar 

  7. Nyarady Z, Sari F, Olasz L, Nyarady J (2006) Submental endotracheal intubation in concurrent orthognathic surgery: a technical note. J of Cranio Maxillofac Surg 34:362–365

    Article  Google Scholar 

  8. Gadre KS, Kushte D (1992) Transmylohyoid oroendotracheal intubation: a novel method. J Craniofac Surg 3:39–40

    Article  PubMed  CAS  Google Scholar 

  9. Kiran Shrikrishna Gadre, Pushkar Prakash Waknis (2010) Transmylohyoid/Submental intubation: review, analysis, and refinements. J Craniofac Surg 21(2):516–519

    Article  Google Scholar 

  10. Gordon NC, Tolstunov L (1995) Submental approach to oroendotracheal intubation in patients with midfacial fractures. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 79:269–272

    Article  PubMed  CAS  Google Scholar 

  11. Honig JF, Braun U (1993) Laterosubmental tracheal intubation. An alternative method to nasa-loral intubation or tracheostomy in single step treatment of panfacial multiple fractures or osteotomies. Anaesthesist 42:256–258

    PubMed  CAS  Google Scholar 

  12. Mak PH, Ooi RG (2002) Submental intubation in a patient with beta-thalassaemia major undergoing elective maxillary and mandibular osteotomies. Br J Anaesth 88:288–291

    Article  PubMed  CAS  Google Scholar 

  13. Langford R (2009) Complication of submental intubation. Anaesth Intensive Care 37(2):325–326

    PubMed  CAS  Google Scholar 

  14. Caubi AF, Vasconcelos BC, Vasconcellos RJ, de Morais HHA, Rocha NS (2008) Submental intubation in oral maxillofacial surgery: review of the literature and analysis of 13 cases. Med Oral Patol Oral Cir Bucal 13(3):E197–E200

    PubMed  Google Scholar 

  15. Meyer C, Valfrey J, Kjartansdottir T et al (2003) Indication for and technical refinements of submental intubation in oral and maxillofacial surgery. J Cranio Maxillofac Surg 31:383–388

    Article  Google Scholar 

  16. Green JD, Moore UJ (1996) A modification of sub-mental intubation. Br J Anaesth 77:789–791

    Article  PubMed  CAS  Google Scholar 

  17. Cooper RM (1997) Conversion of a nasal to an orotracheal intubation using an endotracheal tube exchanger. Anesthesiology 87:717–718

    Article  PubMed  CAS  Google Scholar 

  18. Werther JR, Richardson G, McIlwain MR (1994) Nasal tube switch: converting from a nasal to an oral endotracheal tube without extubation. J Oral Maxillofac Surg 52:994–996

    Article  PubMed  CAS  Google Scholar 

  19. Drolet P, Girard M, Poirier J, Grenier Y (2000) Facilitating submental endotracheal intubation with an endotracheal tube exchanger. Anesth Analg 90:222–223

    Article  PubMed  CAS  Google Scholar 

  20. Hernandez Altemir F, Hernandez Monotero S (2000) The submental route revisited using the laryngeal mask airway: a technical note. J Cranio Maxillofac Surg 28:343–344

    Article  Google Scholar 

  21. Schutz P, Hamed HH (2008) Submental intubation versus tracheostomy in maxillofacial trauma patients. J Oral Maxillofac Surg 66:1404–1409

    Article  PubMed  Google Scholar 

  22. Biglioli F, Mortini P, Goisis M et al (2003) Submental orotracheal intubation: an alternative to tracheostomy in transfacial cranial base surgery. Skull Base Surg 13:189–195

    Article  Google Scholar 

  23. Manganello-Souza LC, Tenorio-Cabezas N, Piccinini Filho L (1998) Submental method for orotracheal intubation in treating facial trauma. Rev Paul Med 116:1829–1832

    CAS  Google Scholar 

  24. Chandu A, Smith ACH, Gebert R (2000) Submental intubation: an alternative to short-term tracheostomy. Anaesth Intensive Care 28:193–195

    PubMed  CAS  Google Scholar 

  25. Paetkau DJ, Stranc MF, Ong BY (2000) Submental orotracheal intubation for maxillofacial surgery. Anesthesiology 92:912

    Article  PubMed  CAS  Google Scholar 

Download references

Conflict of interest

I have no any conflict of interest regarding any of financial and personal relationships with other people and organisations that could inappropriately influence (bias) my work.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Abhishek S. Tidke.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tidke, A.S., Borle, R.M., Madan, R.S. et al. Transmylohoid/Submental Endotracheal Intubation in Pan-facial Trauma: A Paradigm Shift in Airway Management with Prospective Study of 35 Cases. Indian J Otolaryngol Head Neck Surg 65, 255–259 (2013). https://doi.org/10.1007/s12070-012-0505-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12070-012-0505-x

Keywords

Navigation