Fixation of an oral tracheal tube to the maxilla in maxillofacial surgery.

To the Editor: Securing the orotracheal tube is a challenge in maxillofacial surgery. Blood, saliva, and disinfectant solutions interfere with tape adhesion (1). Surgeons frequently reposition the head, further jeopardizing the security of the orotracheal tube. Several methods of securing oral endotracheal tubes have been described: anchoring the endotracheal tube with circummandibular wire (2) or a standard dental arch bar (3), affixing wire between the endotracheal tube and the cervix of a stable tooth (4), using a dental rubber dam clamp (5) or screw fixation to the maxilla (6). We report another method of affixing an oral tracheal tube in a case of midfacial fracture. A 25-yr-old man sustained maxillofacial injury from a motor vehicle accident. Clinical and radiological examination revealed bilateral Lefort Type 2 fracture of the midface, nasoorbito-ethmoidal complex fracture, and fracture of the mandible at the parasymphysis. The patient was scheduled to undergo open reduction and internal fixation of his maxilla, mandible with nasal bone manipulation and stabilization. Airway examination showed an adequate mouth opening with avulsed maxillary central incisors and right lateral incisor. After we induced general anesthesia and neuromuscular blockade, we intubated the trachea with a 38F flexometallic tube. We drilled a hole above the maxillary central incisors’ socket in the thick alveolar bone and threaded a 6-mm intermaxillary fixation screw into the hole. We secured the endotracheal tube to the screw using 26-gauge dental wire (Fig. 1). This permitted proper alignment of the teeth, and completion of the surgery without risk of extubation. At the end of the procedure, we reversed the neuromuscular blockade, extubated the trachea, and removed the maxillary screw, without any complication.