Folia Medica Cracoviensia

In 1995 the fi rst tracheosubmental intubation (TSI) in Poland was performed in the Clinic and Department of Cranio-Maxillofacial Surgery at Jagiellonian University Medical College in Kraków. Our 20 years of experience with using TSI in the fi eld of cranio-maxillofacial surgery, with 316 successfully performed intubations, resulted in one of the largest bodies of material analysed in the literature so far. Th e aim of this study was to evaluate the effi cacy and complications of TSI in the fi eld of cranio-maxillofacial surgery in patients where orotracheal or nasotracheal intubation is contraindicated and tracheostomy can be avoided. To fulfi l this objective we present our own experience with the use of TSI in the fi eld of cranio-maxillofacial surgery. Th is retrospective study included 316 patients who were operated on with general anaesthesia via TSI in the Department of Cranio-Maxillofacial Surgery, Jagiellonian University Medical College, Kraków, from 1995 to 2014 (20 years). Indications for TSI were as follows: multifragmentaric fractures of the bones of midand lower face in 262 patients (82.9%), simultaneous osteotomies of the maxilla and mandible due to mandibular prognathism with maxillary compression in 62 patients (19.6%), extensive facial cancer infi ltrating both the nose and lips in 4 patients (1.2%) and posttraumatic deformities of the nose and jaws in 4 patients (1.2%). In all 316 patients TSI was successfully performed and proved to be the optimal method of airway management, providing a comfortable surgical approach with the operating fi eld free from an intubation tube. Complications were observed in 12 patients (3.8%) and included wound infection in 7 patients (2.21%), transitory salivary fi stula in 3 patients (0.95%), and hypertrophic scarring in 2 patients (0.63%). TSI is considered to be a safe and simple technique of intubation, which makes it possible to to avoid tracheotomy complications when it is diffi cult or impossible to perform orotracheal or nasotracheal intubation. TSI facilitates the simultaneous performance of complex procedures, including both mid-face and lower face correction, in a one-step procedure, providing complete intraoperative control of the occlusion as well as facial symmetry. 80 Aleksandra Szantyr, Mariusz Szuta, et al.