Submandibular intubation

Sharing the airway is a major concern for both anaesthetist and surgeon because the security of the airway may be jeopardized and the tracheal tube might impede the surgical field. This is seen typically in maxillofacial and ENTsurgeries. Nasal intubation is widely exercised by anaesthetists in maxillofacial surgery but difficulties arise with panfacial fractures when an unobstructed surgical field is required to provide good occlusion, jaw wiring, nasal manipulation and maxillomandibular fixation in the same procedure. Submandibular intubation is an atypical method of establishing a definitive airway as it does not use the usual anatomic paths to secure the airway. The method was invented by a Spanish maxillofacial surgeon, Francisco Hernandez Altemir, who described the technique of submental intubation in his original work published in 1986 as an alternative to tracheostomy and keeping away from the field of surgery. The technique of submental intubation had been modified to the submandibular approach; in both of these approaches the technique is straightforward and simple.