Clinical evaluation of submental intubation as an alternative airway management technique in midface osteotomy

Abstract

Background: The conventional endonasal intubation would not allow precise intra-operative assessment of the changes to the nasolabial soft tissue complex. Submental intubation allows accurate measurement of nasolabial soft tissue complex with no interference with the occlusion.

Methodology: A clinical prospective study was carried on 20 patients visiting the Oral and Maxillofacial Surgery department diagnosed of dentofacial deformity requiring orthognathic surgery. The patient were intubated by the submental route of anaesthesia. Intraoperatively time taken to perform intubation and bleeding during the surgery was noted. Post-operatively infection, presence or absence of any complications were noted along with the measurement of scar by Vancouver scar scale.

Results: Out of 20 patients 17 patients required only maxillary osteotomies whereas 3 patients required bimaxillary osteotomy. The mean time taken for intubation was 5.68 ± 1.257 minutes. In all the cases the scar was measured as minimum. 2 patients showed infection at the site of submental intubation after 7th day while after 14th day there was no infection present. No other complication was noted. 19 out of 20 cases showed no interference during the procedure whereas in 1 case mild interference during mandibular movement.

Conclusion: The submental intubation is a very good alternative to nasotracheal intubation in the patients undergoing bimaxillary surgeries or maxillary surgeries. Submental intubation can be chosen whenever possible, as it is easy, takes little time and follow-up is simple, does not result in bleeding or other complications and more importantly does not result in any unaesthetic scar after 3rd month follow up.

Keywords: Intubation; Orthognathic surgery; Submental.