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Submental intubation: A useful alternative for orthognathic surgery in patients with craniofacial malformations. Case report☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1097/01819236-201712001-00012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Submental intubation: A useful alternative for orthognathic surgery in patients with craniofacial malformations. Case report. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1016/j.rcae.2016.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Ali S, Athar M, Ahmed SM, Siddiqi OA, Badar A. A Randomized Control Trial of Awake Oral to Submental Conversion versus Asleep Technique in Maxillofacial Trauma. Ann Maxillofac Surg 2017; 7:202-206. [PMID: 29264286 PMCID: PMC5717895 DOI: 10.4103/ams.ams_10_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Aim This study was designed to evaluate the efficacy of awake oral to submental conversion over asleep technique. Materials and Methods This randomized clinical study was conducted in maxillofacial department of a tertiary care hospital in patients who had panfacial or mandibular fractures requiring elective surgical correction. The patients were randomly divided into two groups of 12 patients each, asleep fiberoptic-assisted submental intubation (SMI) (Group G; n = 12) and awake fiberoptic-assisted SMI (Group A; n = 12). The primary predictor was mean conversion time of oral to SMI while other predictors were overall success rate, ease of conversion, and complications. Data are presented as mean (±standard deviation) and frequencies (%) as appropriate. Statistical analysis done using unpaired t-test or Chi-square test was performed and P < 0.05 was considered statistically significant. Results Twenty-four patients (19:5;Male:Female) aged 18-55 years (Group G = 35.96; Group A = 32.43 years) were included in the study. SMI was successful in all except two patients in group G. Overall success rate was similar in both groups. Time to convert orotracheal intubation to SMI was significantly less in group A (Group G = 9.55 ± 1.42, Group A = 5.67 ± 1.73; P < 0.001). Ease of SMI was found Grade I in 30% and 83% of the patients of group G and A, respectively. No serious complications were observed except 2 cases of bleeding, and 1 case of tube damage. Conclusion Awake oral to submental conversion requires lesser time in comparison to asleep technique besides improving the ease (Δ = 53%) of the procedure.
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Affiliation(s)
- Shahna Ali
- Department of Anaesthesiology and Critical Care, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Manazir Athar
- Department of Anaesthesiology and Critical Care, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Syed Moied Ahmed
- Department of Anaesthesiology and Critical Care, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Obaid Ahmad Siddiqi
- Department of Anaesthesiology and Critical Care, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Amrin Badar
- Department of Anaesthesiology and Critical Care, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
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Navas-Aparicio MDC, Díaz y Faz R. Intubación submentoniana: una alternativa útil para cirugía ortognática en pacientes con malformaciones craneofaciales. Informe de caso. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1016/j.rca.2016.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Hassanein AG, Abdel Mabood AMA. Can Submandibular Tracheal Intubation Be an Alternative to Tracheotomy During Surgery for Major Maxillofacial Fractures? J Oral Maxillofac Surg 2016; 75:508.e1-508.e7. [PMID: 27886977 DOI: 10.1016/j.joms.2016.10.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 10/08/2016] [Accepted: 10/11/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE During surgery for major maxillofacial fractures, orotracheal intubation can interfere with some surgical procedures and nasal intubation can be contraindicated or impossible. That is why tracheotomy is presented as a solution, although it carries a relatively high incidence of complications. In this study, the use of submandibular tracheal intubation is basically evaluated as an alternative to tracheotomy in such circumstances. MATERIALS AND METHODS This prospective study was performed in patients undergoing surgery for major maxillofacial fractures in which oral intubation and/or nasal intubation have been unsuitable, impossible, or contraindicated. The technique of submandibular intubation was assessed intraoperatively and in the postoperative period. The outcomes and complications are presented. RESULTS The study included 26 patients aged between 14 and 57 years. All patients had mandibular fractures, with 19 midface fractures (73.1%), 11 nasal bone fractures (42.3%), 10 zygomatic bone fractures (38.5%), 9 naso-orbito-ethmoidal fractures (34.6%), and 9 frontobasilar fractures (34.6%). The procedure time ranged from 5 to 12 minutes (mean, 7 minutes 4.6 seconds). Delayed extubation was performed in 15 cases (57.7%) in which the tube was left in place for a period ranging from 8 to 50 hours (mean, 30 hours 24 minutes). The technique has proved to be straightforward and satisfactory. A postoperative superficial infection occurred in 2 patients, whereas hypertrophic scars occurred in another 2 patients. CONCLUSIONS Submandibular endotracheal intubation is straightforward, safe, and quick to carry out. It can be an alternative to tracheotomy as it allows operative techniques and postoperative airway protection without the risks and side effects of tracheotomy.
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Affiliation(s)
- Ahmed Gaber Hassanein
- Lecturer of Maxillofacial and Plastic Surgery, Maxillofacial Head and Neck Surgery Unit, General Surgery Department, Faculty of Medicine, Sohag University, Sohag, Egypt.
| | - Ahmed M A Abdel Mabood
- Lecturer of Anesthesia, Anesthesia Department, Faculty of Medicine, Sohag University, Sohag, Egypt
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Banerjee PK, Jain A, Behera B. Submandibular intubation as an alternative for intra-operative airway management in maxillofacial fractures - our institutional experience. Indian J Anaesth 2016; 60:573-7. [PMID: 27601740 PMCID: PMC4989808 DOI: 10.4103/0019-5049.187789] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background and Aims: Airway management in anaesthesia for maxillofacial surgical procedures is tricky at times when the nasal/oral routes are contraindicated or are impossible. Tracheostomy as an alternative inherits its own complications. We present a case series of the submandibular route for tracheal intubation as an alternative. Methods: The procedure was performed in ten selected adult patients with maxillofacial/mandibular fractures associated with a fracture of skull base or nasal bone. All of them were medically stable with no need of intensive care or mechanical ventilation in post-operative period. Results: Submandibular intubation in all ten patients of panfacial fractures allowed uninterrupted surgical techniques with a secured airway. All patients were reverted to oro-tracheal tube at the end of surgery as immediate maxillomandibular fixation was not necessary. The patients were extubated after recovery from anaesthesia before they left the operating theatre. One patient in the post-operative period had a superficial infection of incision site that responded well to local treatment. No other complications were encountered in the intra-operative or post-operative period. Conclusion: In complex maxillofacial injuries, when oral or nasal intubation hampers surgeon's field of view, submandibular intubation offers an effective alternative to short-term tracheostomy along with small risk potential. There is a need to emphasise its regular application in such cases so that technique can be mastered by both surgeons and anaesthesiologist.
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Affiliation(s)
- Praveer K Banerjee
- Department of ENT and Head and Neck Surgery, JLN Hospital and RC, Bhilai, Chhattisgarh, India
| | - Abhineet Jain
- Department of ENT and Head and Neck Surgery, JLN Hospital and RC, Bhilai, Chhattisgarh, India
| | - Bikram Behera
- Department of Anaesthesilogy, JLN Hospital and RC, Bhilai, Chhattisgarh, India
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Singaram M, Ganesan I, Kannan R, Kumar R. Evaluation of safety and usefulness of submental intubation in panfacial trauma surgery. J Korean Assoc Oral Maxillofac Surg 2016; 42:99-104. [PMID: 27162750 PMCID: PMC4860386 DOI: 10.5125/jkaoms.2016.42.2.99] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 01/12/2016] [Accepted: 01/15/2016] [Indexed: 11/30/2022] Open
Abstract
Objectives Submental intubation has been advocated as an alternative to classical tracheostomy for certain indicated panfacial trauma surgeries. Surgeons should have various options for airway management in maxillofacial trauma patients. Most maxillofacial injuries involve occlusal derangements, which might require intraoperative occlusal corrections; hence, orotracheal intubation is not ideal. Maxillofacial surgeons generally prefer nasotracheal intubation; however, in cases with concomitant skull base fracture or nasal bone fracture, nasotracheal intubation might not be suitable; in these situations, tracheostomy is typically performed. However, the possible complications of tracheostomy are well known. Due to trauma situations and to avoid the complications of tracheostomy, submental intubation would be an ideal alternative procedure in selected maxillofacial trauma surgery patients. This study aimed to evaluate the safety and usefulness of a submental intubation technique for panfacial trauma surgery. Moreover, we intended to share our experience of submental intubation and to recommend this simple, safe procedure for certain panfacial trauma surgeries. Materials and Methods In five panfacial trauma patients, we performed submental intubation for airway management; the mean time required for the procedure was only eight minutes. Results We were able to execute this procedure safely in a short time without any intraoperative or postoperative complications. Conclusion Submental intubation is a safe and simple technique for airway management in indicated panfacial trauma surgery patients.
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Affiliation(s)
- Mohanavalli Singaram
- Department of Dentistry, ESIC Medical College and Postgraduates Institute of Medical Sciences and Research (PGIMSR), Chennai, India
| | - Ilango Ganesan
- Department of Anesthesiology, ESIC Medical College and Postgraduates Institute of Medical Sciences and Research (PGIMSR), Chennai, India
| | - Radhika Kannan
- Department of Anesthesiology, ESIC Medical College and Postgraduates Institute of Medical Sciences and Research (PGIMSR), Chennai, India
| | - Rajesh Kumar
- Department of Dentistry, ESIC Medical College and Postgraduates Institute of Medical Sciences and Research (PGIMSR), Chennai, India
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Rahpeyma A, khajeh Ahmadi S. Submental intubation in maxillofacial trauma patients. IRANIAN JOURNAL OF OTORHINOLARYNGOLOGY 2013; 25:17-22. [PMID: 24303414 PMCID: PMC3846236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 07/22/2012] [Indexed: 10/24/2022]
Abstract
INTRODUCTION To describe a modified technique for submental intubation in severely traumatized maxillofacial patients and to evaluate complications arising from the procedure. MATERIALS AND METHODS Submental intubation was performed in twelve patients with maxillofacial trauma ,from 2007-2012, which were operated under general anesthesia for treatment of facial fractures. RESULTS The patients ranged in age from 14 to 39 years. No complications due to submental intubation, such as infection, hypertrophic scarring, lingual nerve injury, hematoma, bleeding, ranula formation, or orocutaneous fistula, were observed following submental intubation. CONCLUSION Submental intubation is a very useful technique in the management of maxillofacial trauma patients, with a low complication rate.
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Affiliation(s)
- Amin Rahpeyma
- Oral and Maxillofacial Diseases Research Center, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Saeedeh khajeh Ahmadi
- Dental Research Center ,Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran.,Corresponding Author: Dental Research Center ,Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran. P.O. Box: 91735-984, Tel: 09155205298, E-mail:
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Abstract
Airway management in patients with faciomaxillary injuries is challenging due to disruption of components of upper airway. The anesthesiologist has to share the airway with the surgeons. Oral and nasal routes for intubation are often not feasible. Most patients have associated nasal fractures, which precludes use of nasal route of intubation. Intermittent intraoperative dental occlusion is needed to check alignment of the fracture fragments, which contraindicates the use of orotracheal intubation. Tracheostomy in such situations is conventional and time-tested; however, it has life-threatening complications, it needs special postoperative care, lengthens hospital stay, and adds to expenses. Retromolar intubation may be an option, But the retromolar space may not be adequate in all adult patients. Submental intubation provides intraoperative airway control, avoids use of oral and nasal route, with minimal complications. Submental intubation allows intraoperative dental occlusion and is an acceptable option, especially when long-term postoperative ventilation is not planned. This technique has minimal complications and has better patients’ and surgeons’ acceptability. There have been several modifications of this technique with an expectation of an improved outcome. The limitations are longer time for preparation, inability to maintain long-term postoperative ventilation and unfamiliarity of the technique itself. The technique is an acceptable alternative to tracheostomy for the good per-operative airway access.
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Affiliation(s)
- Sabyasachi Das
- Department of Anaesthesiology, North Bengal Medical College, P.O.-Sushrutanagar, Dist- Darjeeling, West Bengal, India
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Faraj JH, Al Khalil M, Darwish A, Faraj I, El Zenati H, Eltiraifi Y, Nassir F. Submandibular intubation. Qatar Med J 2012; 2012:88-91. [PMID: 25003049 PMCID: PMC3991042 DOI: 10.5339/qmj.2012.2.21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Accepted: 12/01/2012] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jafar H Faraj
- Sr. Consultant, Anesthesia/ICU, Department of Anesthesia/ICU, Pain & Palliative Care, Hamad General Hospital, PO Box 3050, Doha, Qatar
| | - M Al Khalil
- Sr. Consultant, Anesthesia/ICU, Department of Anesthesia/ICU, Pain & Palliative Care, Hamad General Hospital, PO Box 3050, Doha, Qatar
| | - Az Darwish
- Sr. Consultant, Anesthesia/ICU, Department of Anesthesia/ICU, Pain & Palliative Care, Hamad General Hospital, PO Box 3050, Doha, Qatar
| | - I Faraj
- Sr. Consultant, Anesthesia/ICU, Department of Anesthesia/ICU, Pain & Palliative Care, Hamad General Hospital, PO Box 3050, Doha, Qatar
| | - H El Zenati
- Sr. Consultant, Anesthesia/ICU, Department of Anesthesia/ICU, Pain & Palliative Care, Hamad General Hospital, PO Box 3050, Doha, Qatar
| | - Y Eltiraifi
- Sr. Consultant, Anesthesia/ICU, Department of Anesthesia/ICU, Pain & Palliative Care, Hamad General Hospital, PO Box 3050, Doha, Qatar
| | - F Nassir
- Sr. Consultant, Anesthesia/ICU, Department of Anesthesia/ICU, Pain & Palliative Care, Hamad General Hospital, PO Box 3050, Doha, Qatar
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