Submental intubation in orthognathic surgery: initial experience
Introduction
Submental intubation was described by Altemir1 almost 20 years ago and is now a recognised technique of airway control in the management of severe maxillofacial injuries. It allows short term, non-obstructed access to the maxillofacial skeleton, particularly when nasal intubation is contraindicated, allowing intermaxillary fixation without compromise to the airway.2 Although described initially for trauma, submental intubation has also been described recently in the setting of orthognathic surgery.3 With conventional endonasal intubation, precise intraoperative assessment of the changes to the nasolabial complex, assessment of midlines, cant, and incisor display cannot be made accurately during orthognathic procedures. Adjunctive procedures, such as simultaneous rhinoplasty, cannot be done without changing the tube. Because of the perceived advantages of submental intubation over conventional nasotracheal intubation, we have used it in our unit during the last three years as an alternative to nasal intubation in patients having maxillary orthognathic procedures. This is a preliminary report of our results.
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Patients and methods
Hospital records of patients having orthognathic operations with submental intubation were reviewed retrospectively for a period of three years. Data recorded included personal details, the procedure, the type of dentofacial deformity, and complications related to the use of submental intubation.
Oral endotracheal intubation was initially done using an 8.0 mm, armoured endotracheal tube with a detachable connector (Intravent Orthofix, Berkshire, UK). This forms part of an intubating laryngeal
Results
A consecutive series of 44 patients were identified and included in the study. All cases were under the care of one or two consultant maxillofacial surgeons (AS or HW). The mean (SD) age of patients was 24 (7) years. The type of dentofacial deformities treated are listed in Table 1. Forty- two patients (96%) had bimaxillary procedures, and two patients (5%) had maxillary procedures only. Two patients had simultaneous rhinoplasty and two had submental liposuction and platysmal plication,
Discussion
Several reports have described the use of submental intubation in severe maxillofacial injuries,1, 4, 5 although apart from isolated case reports,5, 6, 7, 8 few authors have described its use in the management of dentofacial deformities. Nyarady et al.3 described its use in 13 patients having orthognathic surgery, and found no perioperative or postoperative complications. As in the present study, the submental intubation did not interfere with the mandibular procedure.3 It has also been
Acknowledgements
We thank Dr Raymond Edler, consultant orthodontist for reviewing the manuscript.
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