Submental intubation in patients with maxillofacial fractures: case report and literature review

Abstract

Background: Conventional orotracheal and nasotracheal intubation can be challenging in patients requiring fixation of fractures of the maxillofacial skeleton. The proximity of the surgical site for maxillofacial procedures to the airway predisposes patients with maxillofacial pathologies to anaesthetic complications like dislodged endotracheal (ET) tubes and inadvertent extubation. The need for maxillomandibular fixation (MMF) as part of fracture management precludes the use of orotracheal intubation. In patients with nasal bone fractures, nasotracheal intubation may not be feasible, and the complications associated with tracheostomy make it a last resort for securing access to the airway. The purpose of this article is to highlight the usefulness of submental intubation in the management of patients with maxillofacial fractures.
Case presentation: We present our initial experience with the submental route of intubation and illustrate the procedure with a case of a patient with midface fractures successfully managed using submental intubation. A literature review of alternative airway routes to conventional orotracheal and nasotracheal intubation is also included.
Discussion: Edentulous spaces, retromolar intubation, submental intubation, submandibular intubation, and tracheostomy have been used as alternatives to conventional endotracheal intubation. Each route has its associated advantages, disadvantages, and limitations.
The submental approach is fast, easy to learn, and associated with minimal complications.
Conclusion:Submental intubation is a safe option for airway management in patients with maxillofacial fractures.