Submental Orotracheal Intubation: An Alternative to Tracheotomy in Transfacial Cranial Base Surgery

ABSTRACT

This retrospective study evaluated the safety and efficacy of submental intubation not only for trauma treatment but also for oncological cranial base surgery. The medical records of 24 patients who underwent submental intubation from 1996 to 2002 were reviewed. There were 6 procedures for craniofacial trauma, 12 transmaxillary approaches to the clivus for clivus chordomas, and 6 transmaxillary approaches to the cranial base for chondrosarcomas. Time required for intubation, accidental extubation, postoperative complications, and the healing of intraoral and submental scars were evaluated. The submental orotracheal intubation was completed successfully in all patients. No accidental extubations or tube injuries occurred. The mean time required for intubation was 5 minutes. The only complication was one case of superficial infection of the submental wound. The intraoral and submental accesses healed with minimal scarring in all patients. Submental orotracheal intubation is a useful and safe technique for airway management of craniomaxillofacial traumas and during transfacial approaches to the cranial base. It avoids the complications associated with tracheostomy. It also permits considerable downward retraction of the maxilla after a Le Fort I osteotomy and is associated with good clival exposure. Furthermore, it does not interfere with maxillomandibular fixation at the end of the surgery.

KEYWORDS

Intubation - submental intubation - chordoma

REFERENCES

• 1 Caron G, Pasquin R, Lessard M, Trepanier C, Landry P E. Submental endotracheal intubation: an alternative to tracheostomy in patients with midfacial and panfacial fractures.  J Trauma . 2000;  48 235-240
• 2 Hall D. Nasotracheal intubation with facial fractures.  JAMA . 1989;  261 1198
• 3 Schultz R C. Nasotracheal intubation in the presence of facial fractures.  Plast Reconstr Surg . 1990;  86 1046
• 4 Muzzi D M, Losasso T J, Cucchiara R F. Complications from a nasopharyngeal airway in a patient with a basilar skull fractures.  Anesthesiology . 1991;  74 366-372
• 5 Bahr W, Stoll P. Nasal intubation in the presence of frontobasal fractures.  J Oral Maxillofac Surg . 1992;  50 445-451
• 6 Martinez-Lage J, Esclava J M, Cebrecos A I, Marcos O. Retromolar intubation.  J Oral Maxillofac Surg . 1998;  56 302-306
• 7 Paetkau D, Strand M, Onc B. Submental orotracheal intubation for maxillofacial surgery.  Anesthesiology . 2000;  92 912-914
• 8 Sekkar L N, Janeka I P. Surgery of the cranial base tumors.  New York: Raven Press 1993: 235-240
• 9 James D, Crockord H A. Surgical access to the base of the skull and upper cervical spine by extended maxillectomy.  Neurosurgery . 1991;  29 411-416
• 10 Altemir F H. The submental route for endotracheal intubation.  J Maxillofac Surg . 1986;  14 64-65
• 11 Biglioli F, Galioto S, Giannì A B, Autelitano L, Goisis M. Applicazione della tecnica di intubazione orotracheale con passaggio submentale nei traumi maxillo-facciali.  Riv It Ch Maxillofac . 1999;  10 19-21
• 12 Drolet P, Girard M, Poirier J, Grenier Y. Facilitating submental endotracheal intubation with an endotracheal tube exchanger.  Anesth Analg . 2000;  90 222-224
• 13 Labbe D, Kaluinski A, Badie-Modiri B. Submental oroendotracheal intubation in craniomaxillofacial trauma.  Ann Chir Plast Esthet . 1998;  43 248-251
• 14 Chew J Y, Cantrell R W. Tracheostomy, complications and their management.  Arch Otolaryngol . 1972;  96 538-545
• 15 Demas P N, Sotereanos G C. The use of tracheotomy in oral and maxillofacial surgery.  J Oral Maxillofac Surg . 1988;  46 483-486
• 16 Waldron J, Padgham N D, Hurley S E. Complications of emergency and elective tracheostomy: a retrospective study of 150 consecutives cases.  Ann R Col Surg Engl . 1990;  72 218-220
• 17 Zeitouni A G, Kost K M. Tracheostomy: a retrospective review of 281 cases.  J Otolaryngol . 1994;  23 61-66
• 18 Werther J R, Richardson G, McIlwain M R. Nasal tube switch: converting from a nasal to an oral endotracheal tube without extubation.  J Oral Maxillofac Surg . 1994;  52 (suppl 9) S994-S996
• 19 Martinez-Lage J L, Eslava J M, Cebrecos A I, Marcos O. Retromolar intubation.  J Oral Maxillofac Surg . 1998;  56 302-306
• 20 Cooper R M. Conversion of a nasal tube to an orotracheal intubation using an endotracheal tube exchanger.  Anesthesiology . 1997;  87 717-718
• 21 Green J D, Moore U J. A modification of sub-mental intubation.  Br J Anaesth . 1996;  77 789-791