Abstract
Securing a definitive airway in patients who require surgical fixation of complex maxillofacial fractures is an integral part of their perioperative management. For the ease of surgical access, an orotracheal tube is usually not preferred by surgeons. The presence of a base of skull or nasal bone fractures would also contraindicate nasotracheal intubation. Therefore, a tracheostomy may be the only option left to secure the airway in these patients who require surgical fixation. Submental intubation has been used as a safe and effective alternative method in patients who require intubation for maxillofacial reconstruction since it was first reported by Hernandez Altemir F in 1986. Many modifications to the original technique have been documented over the years, but there has been no consensus to support the use of a single method or device. In this case report, we described our experience with submental intubation using an LMAFastrachTM endotracheal tube (ETT) to facilitate the surgical fixation of bilateral Le Fort II fractures. We conclude that the LMAFastrachTM ETT is a suitable device for submental intubation. This technique should be included in airway workshops and courses for anaesthesia residents as it is a simple yet secure alternative to tracheostomy in the intraoperative airway management of maxillofacial trauma.
Highlights
We described our experience with submental intubation using an LMAFastrachTM endotracheal tube (ETT) to facilitate the surgical fixation of bilateral Le Fort II fractures
We conclude that the LMAFastrachTM ETT is a suitable device for submental intubation
This technique should be included in airway workshops and courses for anaesthesia residents as it is a simple yet secure alternative to tracheostomy in the intraoperative airway management of maxillofacial trauma
Summary
This technique involves exteriorizing the endotracheal tube (ETT) from the oral cavity into the submental space, thereby allowing the surgeons unhindered access to the oral cavity. It eliminates the risks associated with nasotracheal intubation, and avoids a tracheostomy which would otherwise be the conventional method of airway control [2]. The LMAFastrachTM ETT has been reported to be an ideal device for this technique in view of certain unique design features [5]. In this case report, we document a successful submental intubation using the LMAFastrachTM ETT
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