Skip to main content

Advertisement

SpringerLink
Log in

Intubation Techniques: Preferences of Maxillofacial Trauma Surgeons

  • Technical Note
  • Published:
Journal of Maxillofacial and Oral Surgery Aims and scope Submit manuscript

Abstract

Objective

To evaluate the clinical outcomes of alternative techniques of intubation in patients sustaining maxillofacial injuries, where nasotracheal intubation (NTI) is best avoided.

Material and Methods

Alternative techniques to standard naso-tracheal intubation like submental intubation, orotracheal intubation-retrotuberosity/retromolar and missing dentition were used and variables of clinical outcome recorded.

Results

Submental intubation provides an unobstructed intraoral surgical field, avoids intraoperative and postoperative complications of tracheostomy, and overcomes the disadvantages of NTI. In our experience with submental intubation (6 cases), we only had complication related to tube apparatus like damage to pilot balloon. With retrotuberosity intubation (5 cases) we did not encounter any complications and the only limitations were bulbous maxillary tuberosity. Retromolar intubation (4 cases) a safe noninvasive technique has disadvantages like tube interference within the surgical field and not feasible in case of limited retromolar space. Orotracheal-missing dentition intubation (4 cases) is of great advantage i.e. it can be used in cases where NTI is contraindicated, no specialized skill required, no added cost, avoids the need for tracheostomy, no extra-oral procedures required and does not interfere with occlusion/MMF; with disadvantage of occasional tube interference within the surgical field.

Conclusion

Preferred techniques of securing an airway like orotracheal, nasotracheal may not always be applicable, thus a trauma surgeon-anesthesist team should always have alternative techniques in their armamentarium to reduce the morbidity associated with these patients without interference with occlusion, which is prime goal in jaw fracture reduction. We have used these techniques in a country with limited resources and found them equally effective and convenient to use.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Hall CEH, Shutt LE (2003) Nasotracheal intubation for head and neck surgery. J Anesth 58:249–256

    CAS  Google Scholar 

  2. Meyer C, Valfrey J, Kjartansdottir T, Wilk A, Barierre P (2003) Indication for and technical refinements of submental intubation in oral and maxillofacial surgery. J Craniomaxillofac Surg 31:383–388

    Article  PubMed  Google Scholar 

  3. Taher AA (1992) Nasotracheal intubation in patients with facial fractures. Plast Reconstr Surg 90:1119–1120

    CAS  PubMed  Google Scholar 

  4. Marlow TJ, Goltra DD, Schabel SI (1997) Intracranial placement of a nasotracheal tube after facial fracture: a rare complication. J Emerg Med 15:187–191

    Article  CAS  PubMed  Google Scholar 

  5. Bernard AC, Kenady DE (1999) Conventional surgical tracheostomy as the preferred method of airway management. J Oral Maxillofac Surg 57:310–315

    Article  CAS  PubMed  Google Scholar 

  6. Hafez A, Couraud L, Velly JF, Bruneteau A (1984) Late cataclysmic hemorrhage from the innominate artery after tracheostomy. J Thorac Cardiovasc Surg 35:315–319

    Article  Google Scholar 

  7. Tuzuner-Oncul AM, Kucukyavuz Z (2008) Prevalence and prediction of difficult intubation in maxillofacial surgery patients. J Oral Maxillofac Surg 66:1652–1658

    Article  PubMed  Google Scholar 

  8. Crosby ET, Lui A (1990) The adult cervical spine: implications for airway management. Can J Anaesth 37:77–93

    Article  CAS  PubMed  Google Scholar 

  9. Telford RJ, Liban JB (1991) Awake fibreoptic intubation. Br J Hosp Med 46:182–184

    CAS  PubMed  Google Scholar 

  10. Delaney KA, Hessler R (1988) Emergency flexible fiberoptic nasotracheal intubation: a report of 60 cases. Ann Emerg Med 17:919–926

    Article  CAS  PubMed  Google Scholar 

  11. Agro F, Hung OR, Cataldo R, Carassiti M, Gherardi S (2001) Lightwand intubation using the trachlight: a brief review of current knowledge. Can J Anaesth 48:592–599

    Article  CAS  PubMed  Google Scholar 

  12. Dong Y, Li G, Wu W, Su R, Shao Y (2013) Lightwand-guided nasotracheal intubation in oromaxillofacial surgery patients with anticipated difficult airways: a comparison with blind nasal intubation. Int J Oral Maxillofac Surg 42(9):1049–1053

    Article  CAS  PubMed  Google Scholar 

  13. Altemir FH, Montero SH, Hernández Montero S, Hernández Montero E, Moros Peña M (2004) Hazards of submental tracheal intubation. Anaesthesia 59(1):140

    Google Scholar 

  14. Jundt JS, Cattano D, Hagberg CA, Wilson JW (2012) Submental intubation: a literature review. Int J Oral Maxillofac Surg 41:46–54

    Article  CAS  PubMed  Google Scholar 

  15. Ramsey CA, Dhaliwal SS (2010) Retrograde and submental intubation. Atlas Oral Maxillofacial Surg Clin N Am 18:61–68

    Article  Google Scholar 

  16. Lazaridis et al (2012) Retrotuberosity versus submentosubmandibular and median submental intubation: patients with maxillofacial surgery. Oral Surg Oral Med Oral Pathol Oral Radiol 114(suppl 5):S209–S215

    Article  PubMed  Google Scholar 

  17. Vidya B, Cariappa KM, Kamath AT (2012) Current perspectives in intra operative airway management in maxillofacial trauma. J Maxillofac Oral Surg 11(2):138–143

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  18. Lieger O, Zix J, Kruse A, lizuaka T (2009) Dental injuries in association with facial fractures. J Oral Maxillofac Surg 57(8):4–1660

    Google Scholar 

Download references

Acknowledgements

The authors thank all the faculty and residents from departments of Oral and Maxillofacial Surgery and Anaesthesiology and Critical Care.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Oral and Maxillofacial Surgery, College of Dental Surgery, B.P Koirala Institute of Health Sciences, Dharan, Nepal

    Mehul R. Jaisani, Leeza Pradhan & Alok Sagtani

  2. Department of Anaesthesiology and Critical Care, B.P Koirala Institute of Health Sciences, Dharan, Nepal

    Balkrishna Bhattarai

Authors
  1. Mehul R. Jaisani
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Leeza Pradhan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Balkrishna Bhattarai
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alok Sagtani
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mehul R. Jaisani.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jaisani, M.R., Pradhan, L., Bhattarai, B. et al. Intubation Techniques: Preferences of Maxillofacial Trauma Surgeons. J. Maxillofac. Oral Surg. 14, 501–505 (2015). https://doi.org/10.1007/s12663-014-0679-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12663-014-0679-8

Keywords

Search

Navigation