10 SUBMENTALINTUBATION.cdr

Aims & Objective: Assessment of submental intubation as an intubation option for the facial trauma cases Material &Methods: 15 patients were intubated with submental approach in our institution during a one year time period from August 2009 to July 2010. Result: In our patients, submental intubation gave a better airway intubation for the reduction and fixation of all the facial fracture and intraoperative control of dental occlusion without interference from the tube during operation .No intraoperative and postoperative complication were observed. The wound healing for submental scar was satisfactory and the scar not perceptible. Conclusion: Submental intubation is a simple, safe, useful and effective method to secure airway in major maxillofacial trauma, where oral and nasal endotracheal intubation cannot be performed. It provides added advantage of control of occlusion during the panfacial trauma management. It also avoids the need of tracheostomy and its associated morbidities. 1 2 3 4 Umang Agarwal, Puja Rai, Jasmeet Singh, Rashmi Agarwal Senior Lecturer, Department of Oral & Maxillofacial Surgery, 2 Maharanapratap Dental College, Kanpur. Senior Lecturer, Department of Oral Medicine and Radiology, BBD College of Dental Sciences, Lucknow. Senior Lecturer, Department of Oral &maxillofacial Surgery, 4 BBD, College of Dental Sciences, Lucknow, Reader, Department of Oral & Maxillofacial Surgery, BBD College of Dental Sciences, Lucknow. INTRODUCTION : Management of the airways in the presence of midface or panfacial injuries with mandibular 1 involvement requires special consideration . Surgical repair of maxillofacial trauma requires modification of the standard anaesthesia technique. Different methods of intubation and 2 surgical airways are described in the literature . Nasal endotracheal intubation is often contraindicated in the 3 presence of fracture of base of the skull . Comminuted midfacial fractures cause physical obstruction to the passage of nasotracheal tube. Further, the presence of nasotracheal tube can interfere with surgical reconstruction of fractures of 3 the naso-orbital ethmoid (NOE) complex. Surgical reconstruction often involves maxillo-mandibular fixation in the intraoperative period to restore patient's dental occlusion. This precludes the use of oral endotracheal intubation in such cases. No consensus exists to date as to the best way of controlling the airway when orotracheal or nasotracheal 6 intubations are contraindicated . Tracheostomy remains an excellent procedure for establishing a formal surgical airway. In these conditions tracheostomy may be indicated but it 4 carries a significant morbidity as this procedure may involve a significant risk of iatrogenic complications, such as tracheal stenosis, internal emphysema, damage to the laryngeal 1,7,8. nerves, tracheoesophageal fistula and scarring An alternative to this classic method is submental intubation. Submental endotracheal intubation has been described as a useful alternative to tracheostomy with minimal 9 complications in these conditions . The technique consists of diverting the proximal end of an orotracheal tube through the floor of the mouth into the submental region. This allows free intraoperative access to the dental occlusion and nasal pyramid without endangering patients with skull base trauma, and at the same time avoids 1, 10. transtracheal dissection We describe our experience of submental intubation for panfacial trauma cases in 15 patients. CASE REPORTS : Case 1: A 35 year old, male patient reported to our department of oral & maxillofacial surgery , with a history of road traffic accident five days back from reported date with history of SUBMENTAL INTUBATION FOR PANFACIAL TRAUMA Journal of Dental Sciences University