We read with interest Janakiraman and Rassam’s paper, which suggests many different methods for fixing reinforced tracheal tubes using adhesive tape [1]. However, they ignore some disadvantages of the extra-oral tape fixation of the ETT, particularly when operations involve middle and lower face, and intra-oral sites [2]. First, surgical access to these regions is handicapped by the tape covering and distracting the skin. Second, blood, saliva, sweat, and disinfectant fluid interfere with reliable adhesion of the tape. The operative procedure and frequent reposition of the head may also further jeopardize the security of tracheal tubes. Third, the common adhesive tapes have been shown to have poor adhesion to the reinforced tracheal tube [3]. Fourth, the adhesive tape can not adequately secure an tracheal tube in patients with facial hair, burns or trauma and is not used in those with allergy to adhesive materials. To overcome these problems, several methods of securing the tracheal tube have been described: anchoring the tracheal tube with circum-mandibular wire or a standard dental arch bar, using a dental rubber dam clamp, or screw fixation to the maxilla by drilling [4, 5]. We report another simple intra-oral dental fixation method of the reinforced tracheal tube using the surgical suture. After intubation is successfully complete, a size seven surgical suture with a length of about 30–40 cm is placed on the cervix of a stable tooth via interdental space of its two sides (Fig. 4a) and fixed firmly on the tooth by a ligature (Fig. 4b). Then the suture is wound round the reinforced tracheal tube twice (Fig. 4c) and tightly tied a knot to secure the tube (Fig. 4d). When the surgical sites are middle and lower face or perioral region, a maxillary or mandibular central incisor should be selected and the tube is fixed in median line (Fig. 5a and 5b). If intra-oral surgery is performed, a lateral incisor is best selected and the tube is secured in angle of mouth to avoid its interference to surgical access (Fig. 5c). In patients who are at a high risk of biting the tube during the surgery, both a bite block and a tube should be stabilised together to prevent perforation and obstruction of the reinforced tracheal tube from biting [6] (Fig. 5d). The procedure for the intra-oral dental fixation of a reinforced tracheal tube. (a) Suture is placed on the cervix of a stable tooth via interdental space of its two sides and (b) fixed firmly on the tooth by a ligature. (c) The suture is then wound round the reinforced ETT and d. tightly knotted to secure the tube. (a) The reinforced tracheal tube was secured on the maxillary central incisor using the suture in a patient who received the skin expander embedment in the perioral region. (b) The tube was fixed on the mandibular central incisor using the suture in a patient who received maxillary and nasal surgery. (c) The tube was mounted on the maxillary lateral incisor using the suture in a patient who received an intraoral surgery. (d) Both a bite block and a tube were secured together on the central incisor of upper mandible using the suture in a patient who may bite during surgery. We have used this technique in 3000 patients over the last 10 years, and consider that this method has the following advantages: (1) it can provide reliable tube fixation without undesirable tube displacement or accident extubation; (2) it may avoid the problems of the extra-oral tape fixation and is easier to perform for the anaesthetist compared with the other methods previously reported [4, 5]; (3) it is non-invasive and there is no risk of damaging the oral mucosa and facial skin; (4) the surgeon has a good view of the operative region. However, it is must emphasized that only healthy teeth should be selected. This method is evidently unsuitable for edentulous patients.
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Jan 1, 2016
Craig Rushing 
Open Access
