J Korean Assoc Oral Maxillofac Surg.  2014 Oct;40(5):250-252. 10.5125/jkaoms.2014.40.5.250.

A simple method of intraoperative intubation tube change

• Cho JY
• Kim HM
• Ryu JY

• KMID: 2005456
• DOI: http://doi.org/10.5125/jkaoms.2014.40.5.250

Abstract

Nasotracheal intubation should be performed in patients with jaw fractures because maxillomandibular fixation is required. However, when there are concomitant fractures of the nose and facial bones, an intubation tube positioned at the nose makes it difficult to perform an intricate surgery. In order to overcome these problems, a variety of ways to change the position of the tube have been introduced. We describe a simple technique of switching the tube from a nasal to oral position, which was easily executed in a patient with concomitant nasal and mandibular fractures, accompanied by a literature review.

Keyword

Airway management; Intubation; Jaw fractures

MeSH Terms

Airway Management
Facial Bones
Humans
Intubation*
Jaw Fixation Techniques
Jaw Fractures
Mandibular Fractures
Nose

Figure

• 

  Fig. 1 Nasal endotracheal tube is placed. A long clamp was placed at the level of the tongue base.

• 

  Fig. 2 Clinical photo showing the cutting of the nasal tube just outside of the naris.

• 

  Fig. 3 Clinical photo showing the nasal tube being pulled and delivered orally. Notice the cuff inflation tube remains in the nose.

• 

  Fig. 4 Completion of the nasal tube switch to an oral endotracheal tube without extubation.

Reference

1. Werther JR, Richardson G, McIlwain MR. Nasal tube switch: converting from a nasal to an oral endotracheal tube without extubation. J Oral Maxillofac Surg. 1994; 52:994–996. PMID: 8064470.

2. Hernández Altemir F. The submental route for endotracheal intubation. A new technique. J Maxillofac Surg. 1986; 14:64–65. PMID: 3456416.

3. Martinez-Lage JL, Eslava JM, Cebrecos AI, Marcos O. Retromolar intubation. J Oral Maxillofac Surg. 1998; 56:302–305. PMID: 9496840.

4. Lima SM Jr, Asprino L, Moreira RW, de Moraes M. A retrospective analysis of submental intubation in maxillofacial trauma patients. J Oral Maxillofac Surg. 2011; 69:2001–2005. PMID: 21367502.

5. Goldenberg D, Ari EG, Golz A, Danino J, Netzer A, Joachims HZ. Tracheotomy complications: a retrospective study of 1130 cases. Otolaryngol Head Neck Surg. 2000; 123:495–500. PMID: 11020193.

6. Lee SS, Huang SH, Wu SH, Sun IF, Chu KS, Lai CS, et al. A review of intraoperative airway management for midface facial bone fracture patients. Ann Plast Surg. 2009; 63:162–166. PMID: 19542879.

7. Bonfils P. Difficult intubation in Pierre-Robin children, a new method: the retromolar route. Anaesthesist. 1983; 32:363–367. PMID: 6614426.

8. Arora S, Rattan V, Bhardwaj N. An evaluation of the retromolar space for oral tracheal tube placement for maxillofacial surgery in children. Anesth Analg. 2006; 103:1122–1125. PMID: 17056943.

9. Kirby RR, Gravenstein N, Lobato EB, Gravenstein JS. Airway devices and their application. In : Kirby RR, editor. Clinical anesthesia practice. 2nd ed. Philadelphia: W. B. Saunders;2002. p. 303–328.