Does a Submental Airway Compared to a Tracheostomy Reduce Length of Stay in Craniomaxillofacial Trauma?

Abstract

Patients with craniomaxillofacial trauma (CMT) are at increased risk of airway compromise and may necessitate airway stabilization via a tracheostomy (TO) or cricothyroidotomy. The submental airway (SMA) is an alternative airway and can avoid complications related to TO. The purpose of this study was to compare the SMA to the TO with respect to hospital length of stay (LOS) and number of days with an advanced airway, termed airway days (ADs). This single-center retrospective cohort study included subjects with isolated CMT who required operative treatment with either a TO or SMA at Harborview Medical Center. Subjects were excluded if they required a TO for reasons other than treating their CMT. The predictor variable was airway type. Primary outcome variables were LOS and ADs measured as number of days between admission and discharge dates, and days between establishment of airway and extubation or decannulation dates, respectively. Covariates included age, sex, American Society of Anesthesiology classification, weight, body mass index, substance use, hospital status, facial injury severity scale scores, and airway placement location. Bivariate analysis using independent t test, Mann-Whitney U test, and multiple linear regression analyses were used. P value of <.05 was considered significant. Of the 14 subjects identified, 6 underwent a TO and 8 a SMA. The mean LOS in the TO group was 20.3±15.8days versus 3.9±4.7days in the SMA group (P=.02). Mean AD in the TO group was 13.2±8.4 versus 0.6±0.7 in the SMA group (P=.01). The TO group had a higher number of operations at 2.0±0.6 versus 1.1±0.4 with a SMA (P=.02). After linear regression analysis adjusting for sex, age, weight, and facial injury severity scale, there were no statistically significant differences between the groups. Compared to, SMA has a 5-fold decrease in LOS and 22-fold decrease in ADs on bivariate analysis. An SMA is a viable airway management option for operative treatment of isolated CMT. Further studies are warranted with a larger sample size.