J Korean Assoc Oral Maxillofac Surg.  2018 Feb;44(1):12-17. 10.5125/jkaoms.2018.44.1.12.

Airway management through submental derivation: a safe and easily reproduced alternative for patients with complex facial trauma

• González-Magaña F
• Malagón-Hidalgo HO
• García-Cano E
• Vilchis-López R
• Fentanes-Vera A
• Ayala-Ugalde FA

• KMID: 2405371
• DOI: http://doi.org/10.5125/jkaoms.2018.44.1.12

Abstract

OBJECTIVES
Airway management in patients with panfacial trauma is complicated. In addition to involving facial lesions, such trauma compromises the airway, and the use of intermaxillary fixation makes it difficult to secure ventilation by usual approaches (nasotracheal or endotracheal intubation). Submental airway derivation is an alternative to tracheostomy and nasotracheal intubation, allowing a permeable airway with minimal complications in complex patients.
MATERIALS AND METHODS
This is a descriptive, retrospective study based on a review of medical records of all patients with facial trauma from January 2003 to May 2015. In total, 31 patients with complex factures requiring submental airway derivation were included. No complications such as bleeding, infection, vascular, glandular, or nervous lesions were presented in any of the patients.
RESULTS
The use of submental airway derivation is a simple, safe, and easy method to ensure airway management. Moreover, it allows an easier reconstruction.
CONCLUSION
Based on these results, we concluded that, if the relevant steps are followed, the use of submental intubation in the treatment of patients with complex facial trauma is a safe and effective option.

Keyword

Submental derivation; Complex facial trauma; Safety; Efficacy

MeSH Terms

Airway Management*
Hemorrhage
Humans
Intubation
Medical Records
Methods
Retrospective Studies
Tracheostomy
Ventilation

Figure

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  Fig. 1 Incision mark.

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  Fig. 2 Blunt dissection through incision.

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  Fig. 3 Schematization of anatomical structures around the dissection.

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  Fig. 4 Visualization of the Kocher clamp on the floor of the mouth.

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  Fig. 5 Schematization of anatomical structures around the dissection on the floor of the mouth.

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  Fig. 6 Passage of the endotracheal tube through the dissection channel.

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  Fig. 7 Fixation of the endotracheal tube.

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  Fig. 8 Schematization of final endotracheal tube position.

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