Submental Intubations in Panfacial Fractures

Ravish Mishra; Deepak Yadav; Shashank Tripathi; Laxmi Kandel; Pawan Puspa Baral; Snigdha Shubham; Abhishek Karn; Kishor Dutta

doi:10.2147/CCIDE.S228326

Submental Intubations in Panfacial Fractures

Clin Cosmet Investig Dent. 2020 Feb 19:12:41-48. doi: 10.2147/CCIDE.S228326. eCollection 2020.

Authors

Ravish Mishra¹, Deepak Yadav¹, Shashank Tripathi¹, Laxmi Kandel¹, Pawan Puspa Baral², Snigdha Shubham³, Abhishek Karn⁴, Kishor Dutta⁵

Affiliations

¹ Department of Oral and Maxillofacial Surgery, UCMS College of Dental Surgery, Bhairahawa, Rupandehi, Nepal.
² Department of Anaesthesiology and Critical Care, Universal College of Medical Sciences, Bhairahawa, Rupandehi, Nepal.
³ Department of Conservative Dentistry and Endodontics, UCMS College of Dental Surgery, Bhairahawa, Rupandehi, Nepal.
⁴ Department of Forensic Medicine and Toxicology, Universal College of Medical Sciences, Bhairahawa, Rupandehi, Nepal.
⁵ Department of Orthodontics and Dentofacial Orthopaedics, UCMS College of Dental Surgery, Bhairahawa, Rupandehi, Nepal.

Abstract

Introduction: Airway management in patients with panfacial fracture remains a challenge to anesthesiologists and surgeons. Submental intubation is an effective and less invasive alternative to tracheostomy during intraoperative airway management where orotracheal and nasotracheal intubation are not appropriate options. In addition, submental intubation allows proper access to oronasal airways and occlusion during intraoperative management.

Methods: The descriptive retrospective study was carried out and evaluated the outcomes of submental intubation in the management of panfacial fracture, complex maxillary or mandible fracture associated with nasal bone fracture and naso-orbito-ethmoid (NOE) fracture. The medical records of 23 patients who received submental endotracheal intubation were reviewed at UCMS College of Dental Surgery, Bhairahawa, Rupandehi, Nepal from March 2014 to December 2018. The following parameters were evaluated: mode of trauma, time required for intubation, accidental extubation, accidental perforation of the pilot balloon during its insertion, period of hospital stay, post-operative complications, such as the healing of submental scars both intraorally and extraorally.

Results: The submental intubation was successfully done in all patients with minimal obvious post-operative complications. The mode of trauma for majority of cases of panfacial fracture who underwent submental intubation was road traffic accident (69.56%). The mean time required for intubation was 8.43 (±0.84) minutes. No accidental extubations occurred. Accidental perforation of the pilot balloon was seen in one patient (4.35%) during tube manipulation which was managed successfully by changing the tube. The healing of submental scars was uneventful intraorally and extraorally in almost every case. The mean period of hospital stay in patients with submental intubation was 7.95 (±1.49) days.

Discussion: Submental intubation is an effective and safe method as it is not associated with complications of tracheostomy during management of panfacial fracture, NOE fracture and craniofacial fracture. In addition, it does not interfere with IMF during intraoperative period.

Keywords: airway management; intermaxillary fixation; panfacial fracture; submental intubation.