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Troise S, Committeri U, Barone S, Palumbo D, D'Auria D, Arena A, Romano A, Salzano G, Abbate V, Raccampo L, Sembronio S, Vaira LA, Dell'Aversana Orabona G, Califano L, Piombino P. Submental intubation in complex maxillofacial trauma: Pilot balloon protection. J Craniomaxillofac Surg 2024; 52:212-221. [PMID: 38143159 DOI: 10.1016/j.jcms.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/02/2023] [Accepted: 12/11/2023] [Indexed: 12/26/2023] Open
Abstract
AIMS This study aims to describe our refined technique of submental intubation to avoid the recorded intraoperative complications related to tube passage and pilot balloon rupture. CASE SERIES This is a retrospective case series of 21 patients with complex maxillofacial trauma who underwent submental intubation from January 2019 to January 2023. All the patients underwent to the same procedure with a new technique of pilot balloon protection: the pilot balloon was not deflated because, once the connector was removed, only the tube was curved and passed through the incision extraorally while the cuff remained inflated. The wire of the pilot balloon was passed behind the last tooth so as not to interfere with the maxillary-mandibular fixation, remaining extraorally under the anesthetist's view. DISCUSSION Only 2 patients (9.5%) reported complications related to submental intubation: in particular a patient (4.8%) reported oral floor infection, and in another patient (4.8%) an unesthetic skin scar was observed. No patients reported intraoperative complications related to the procedure. CONCLUSION The technique of pilot balloon protection that we have proposed seems to be effective in reducing the intraoperative complications related to the passage of the pilot balloon, such as rupture, damage or early extubation.
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Affiliation(s)
- Stefania Troise
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Umberto Committeri
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Simona Barone
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy.
| | - Daniela Palumbo
- Department of Surgical, Anesthesiological Intensive Care and Emergency Sciences, Federico II University of Naples, Naples, Italy
| | - David D'Auria
- Department of Surgical, Anesthesiological Intensive Care and Emergency Sciences, Federico II University of Naples, Naples, Italy
| | - Antonio Arena
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Antonio Romano
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Giovanni Salzano
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Vincenzo Abbate
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Luca Raccampo
- Maxillofacial Surgery Unit, Academic Hospital of Udine, Department of Medicine, University of Udine, 33100, Udine, Italy
| | - Salvatore Sembronio
- Maxillofacial Surgery Unit, Academic Hospital of Udine, Department of Medicine, University of Udine, 33100, Udine, Italy
| | - Luigi Angelo Vaira
- Maxillofacial Surgery Operative Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100, Sassari, Italy
| | - Giovanni Dell'Aversana Orabona
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Luigi Califano
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Pasquale Piombino
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
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Patel A, Saadi R, Lighthall JG. Securing the Airway in Maxillofacial Trauma Patients: A Systematic Review of Techniques. Craniomaxillofac Trauma Reconstr 2020; 14:100-109. [PMID: 33995830 DOI: 10.1177/1943387520950096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Study Design The present study is a systematic review of the literature. Objective The goal of this study is to review our experience and the current literature on airway management techniques in maxillofacial trauma. Methods Independent searches of the PubMed and MEDLINE databases were performed from January 1, 2019 to February 1, 2019. Articles from the period of 2008 to 2018 were collected. All studies which described both airway management and maxillofacial trauma using the Boolean method and relevant search term combinations, including "maxillofacial," "trauma," and "airway," were considered. Results A total of 452 relevant articles in total were identified. Articles meeting inclusion criteria by abstract review included 68 total articles, of which 16 articles were focused on airway management techniques for maxillofacial trauma in the general population and were deemed appropriate for inclusion in the literature review. Conclusions Establishing an effective and stable airway in patients with maxillofacial trauma is of paramount concern. In both the acute setting and during delayed reconstruction, special considerations must be taken when securing a reliable airway in this patient population. The present article provides techniques for securing the airway and algorithms for utilization of these techniques, including both during the initial evaluation and the definitive operative management.
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Affiliation(s)
- Akshilkumar Patel
- The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Robert Saadi
- Department of Otolaryngology - Head and Neck Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Jessyka G Lighthall
- Department of Otolaryngology - Head and Neck Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
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Thirty years of submental intubation: a review. Int J Oral Maxillofac Surg 2018; 47:1161-1165. [PMID: 29731193 DOI: 10.1016/j.ijom.2018.04.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 02/09/2018] [Accepted: 04/17/2018] [Indexed: 11/23/2022]
Abstract
Submental intubation has been used as an alternative to conventional intubation in the field of oral and maxillofacial surgery since its introduction by Francisco Hernández Altemir in 1986. A review of submental intubation was performed using data from all case reports, case-series, and prospective and retrospective studies published between 1986 and 2016. The indications, variations in incision length, incision sites, types of endotracheal tube used, methods of exteriorization, and complications were recorded and analyzed. A total of 70 articles reporting 1021 patients were included. The main indication was maxillofacial trauma (86.9%, n=887), followed by orthognathic surgery (5.8%, n=59), skull base surgery (2.8%, n=29), and rhinoplasty and rhytidectomy (1.5%, n=15). The complication rate was relatively low: 91.0% of patients (n=929) were complication-free. The most common complication was infection, occurring in 3.5% (n=36) of the total number of patients, followed by scarring (1.2%, n=12) and formation of an orocutaneous or salivary fistula (1.1%, n=11). In summary, submental intubation is a good alternative airway with minimal complications.
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Bhola N, Jadhav A, Kala A, Deshmukh R, Bhutekar U, Prasad GSV. Anterior Submandibular Approach for Transmylohyoid Endotracheal Intubation: A Reappraisal with Prospective Study in 206 Cases of Craniomaxillofacial Fractures. Craniomaxillofac Trauma Reconstr 2017; 10:255-262. [PMID: 29109835 DOI: 10.1055/s-0037-1607063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 07/15/2017] [Indexed: 10/18/2022] Open
Abstract
Despite a paradigm shift in anesthesia and trauma airway management, the craniomaxillofacial fracture (CMF) patients continue to pose a challenge. A prospective study was planned between April 2007 and March 2015 to investigate the safety, efficacy, utility, and complications of anterior submandibular approach for transmylohyoid intubation (TMI) in CMFs using an armored endotracheal tube (ETT). Out of 1,207 maxillofacial trauma cases reported, this study recruited 206 patients (152 males and 54 females) aged between 21 and 60 years. No episode of oxygen desaturation was noted intraoperatively. Mean time to perform TMI was 6 ± 2 minutes. The mean transmylohyoid ETT withdrawal time/disconnection time from ventilator was approximately 1.5 minutes. Accidental partial extubation of ETT was noted in two patients (0.97%), and three patients (1.45%) developed abscess formations at anterior submandibular site which were managed by incision and drainage. The anterior submandibular approach for TMI was successfully used and provided stable airway in all elective CMF surgery cases, where oral or nasal intubations were not indicated/feasible and long-term ventilation support was not required. It permitted simultaneous dental occlusion-guided reduction and fixation of all the facial fractures without interference from the tube during the surgery with unhindered maintenance of the anesthesia and airway. The advantages include easy, swift, efficient, and reliable approach with a small learning curve.
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Affiliation(s)
- Nitin Bhola
- Department of Oral and Maxillofacial Surgery, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India
| | - Anendd Jadhav
- Department of Oral and Maxillofacial Surgery, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India
| | - Atul Kala
- Department of Oral and Maxillofacial Surgery, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India
| | - Rahul Deshmukh
- Department of Oral and Maxillofacial Surgery, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India
| | - Umesh Bhutekar
- Department of Oral and Maxillofacial Surgery, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India
| | - G S V Prasad
- Department of Oral and Maxillofacial Surgery, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India
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