Two point fixation of endotracheal tube in submentotracheal intubation during craniomaxillofacial surgeries-our experience!

Abstract

Airway management in the craniomaxillofacial trauma surgery may require some modifications of the standard intubation techniques. Nasotracheal intubation is often not an option in panfacial and midfacial injuries due to the probable presence of fractures of base of the skull and associated risk of brain trauma and iatrogenic meningitis. Submental endotracheal intubation may serve as an effective and safe alternative route in these conditions. In standard technique of submentotracheal intubation, the tube is fixed extraorally at the submental incision site with sutures to prevent displacement of the tube during the surgical intervention. But still it leaves a possibility of accidental extubation during the conversion of orotracheal to submental route and vice versa. To counteract this problem we in our institution, fix the tube at two points, one at molar teeth in intraoral region and second at skin surface externally near submental incision site ensuring a secured airway. This procedure has eliminated accidental displacement or extubation in our cases.