A study to evaluate the efficacy of submental intubation in panfacial trauma

Abstract

Anaesthesia for pan-facial surgeries is challenging because the anaesthesiologist and surgeon have to share the common upper airway field. Oral and nasal routes for intubation are often not feasible. Submental intubation is alternative method to tracheostomy and other modes of intubation for management of airway during maxillofacial surgeries. To provide safe and easy airway with unobstructed intraoral surgical field without causing much morbidity. 30 ASA I and II patients who had pan-facial fracture, including Le Forte II, Le Forte III, with naso-orbital ethmoidal fracture requiring surgical correction admitted in MGM Medical College and MY Hospital Indore were selected for the study. The patients are intubated by submental route and various hemodynamic parameters were evaluated at different time interval during the surgery. In our study, we used two tube method of submental intubation in which another tube was drawn intra oral through submental incision and first tube was replaced. There were no episode of desaturation and no difficulty was encountered in secondary intubation. The average duration of secondary intubation was 3-4 minute (Mean+SD = 3.45+0.95) which is less than the conventional one tube method. As per our experience in study and the review of literature, the submental intubation is very easy and safe method of intubation to provide the unobstructed surgical field for the Le forte II and III panfacial fracture surgeries.