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Year :2015
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Month :
July
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Volume :
4
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Issue :
3
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Page :
6 - 12
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Submental Intubation: A Simple Route of Intubation for Complex Maxillofacial Trauma
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Correspondence Address :
Kumar Nilesh, Neelima A Malik, Panka j Patil, Nilesh Patil, Shambhvi Malik, Mayuri Jobanputra,
CORRESPONDING AUTHOR:
Dr. Kumar Nilesh
Reader, Department of Oral & Maxillofacial Surgery, School
of Dental Sciences, Krishna Hospital, Karad, Satara,
Maharashtra-415 110, India.
E-mail: drkumarnilesh@yahoo.com
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Introduction: Purpose: The aim of the study was to evaluate the use of submental route of intubation for maxillofacial trauma patient, in whom oral and nasal routes of intubation were contraindicated.
Achieving a secure airway is of utmost importance in patients under general anaesthesia. The two most common methods of airway management (intubation) in such patients include oro-tracheal and naso-tracheal intubation. However, both may be contraindicated in complex maxillofacial trauma, like pan-facial fractures requiring surgical access to oral and nasal cavity in the same surgery. Traditionally the only other alternative available in such case is tracheostomy, which is associated with high risk of iatrogenic complications. This work presents our current experience of airway management using submental intubation in such situations. Frequency, indications, steps and outcome of the technique are discussed in details.
Materials and Methods: Patients treated at Krishna hospital, Karad, Maharashtra, India from August 2011 to September 2014, for facial bone fracture under general anaesthesia, in whom both oral and nasal route of intubation was contraindicated, were chosen for submental intubation. Data pertaining to demographics, classification of fracture, time required for intubation and intra-operative & post-operative complication associated with submental route of intubation were recorded.
Results: Out of 252 patients of maxillofacial trauma treated under general anaesthesia, 41 patients underwent submental intubation. Submental intubation allowed simultaneous management of all the fractures (Nasal as well as jaw fractures) and establishment of dental occlusion without any interference with the endotracheal tube. The procedure was simple to execute with no intra-operative complication. Only one patient presented with transient mild lingual haematoma post-operatively, which resolved spontaneously.
Conclusion: Submental intubation is an attractive and viable alternative to tracheostomy in selected patients with multiple facial bone fracture.
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