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Submental intubation versus tracheostomy in maxillofacial fractures

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Abstract

Objective

To compare submental intubation with tracheostomy in patients with maxillofacial fractures who were operated under general anesthesia and nasotracheal intubation was contraindicated.

Patients and methods

This prospective comparative study was conducted on 32 patients undergoing maxillofacial operations. All patients had a panfacial trauma (including naso-ethmoid orbital fracture combined with mandibular fracture). Patients who had unstable cervical vertebra, laryngeal trauma, urgent tracheostomy, and patients with expected prolonged postoperative ventilation were excluded from the study. Patients were randomly assigned to elective tracheostomy and submental intubation groups. The patients were evaluated according to the time required to do elective tracheostomy or submental intubation, the operation comorbidity and complications, and the postoperative scar.

Results

The average time required to do submental intubation was 8.35 min versus 30.75 min required to do elective tracheostomy with significant difference (p < 0.0001). No complication was reported with submental intubation while in elective tracheostomy group, surgical emphysema was registered in two patients. The submental scar was acceptable in all patients while the tracheostomy scar needs scar revision in four cases (p = 0.0325).

Conclusion

Submental endotracheal intubation appeared to be a simple, safe, and significantly faster reliable alternative to tracheostomy during surgical reconstruction of selected cases of maxillofacial fractures without indication for prolonged postoperative ventilation support with significantly lower morbidity.

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Authors and Affiliations

  1. Otorhinolaryngology-Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt

    Tarek Abdelzaher Emara, Mohammad Waheed El-Anwar, Ahmed Anany & Mohamed Mohamed Rabea

  2. Oral and Maxillofacial Surgery Department, Al-Ahrar Teaching Hospital, Zagazig, Egypt

    Tharwat Abdelzaher Omara

  3. Anesthesia and ICU Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt

    Islam Abdelrahman Elawa

Authors
  1. Tarek Abdelzaher Emara
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  2. Mohammad Waheed El-Anwar
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  3. Tharwat Abdelzaher Omara
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  4. Ahmed Anany
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  5. Islam Abdelrahman Elawa
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  6. Mohamed Mohamed Rabea
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Corresponding author

Correspondence to Mohammad Waheed El-Anwar.

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The authors declare that they have no conflict of interests.

Ethical approval

All procedures performed in the study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Emara, T.A., El-Anwar, M.W., Omara, T.A. et al. Submental intubation versus tracheostomy in maxillofacial fractures. Oral Maxillofac Surg 23, 337–341 (2019). https://doi.org/10.1007/s10006-019-00771-4

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  • DOI: https://doi.org/10.1007/s10006-019-00771-4

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