Submental intubation using laparoscopic trocar in zygomaticomaxillary complex fracture surgery in Korea: a case report

Abstract

Submental intubation is an effective alternative technique for airway management in patients with maxillofacial trauma. Compared with tracheostomy, it is less invasive, but has risks associated with potential airway compromise such as hypoxia due to tube obstruction, collapse, and kinking. To shorten procedure time and ensure a reinforced tube lumen, we used a laparoscopic trocar as a new device for submental intubation. A 54-year-old male patient sustained a zygomaticomaxillary complex fracture and was scheduled to undergo open reduction and internal fixation. We performed intraoral intubation and made a small 1-cm incision at the submandibular midline. After dissection of the tissue from the incision site, a reinforced tube was passed using a 12-mm laparoscopic trocar. The procedure took about 5 minutes, and apnea time from disconnecting the breathing circuit and passing through the internal lumen of the trocar until it was reconnected to the ventilator was 1 minute 5 seconds. Using a laparoscopic trocar for submental intubation can reduce the time required for dissection, prevent luminal occlusion complications due to soft tissues or blood clots in the endotracheal tube, and decrease soft tissue damage.

Keywords: Airway management; Case reports; Intratracheal intubation; Maxillofacial injuries; Surgical instruments.

Fig. 1.

The conventional tube is changed by reinforced tube and a skin incision and soft tissue dissection were performed. A laparoscopic trocar was inserted from the skin to the mouth floor. Illustration by Sujin Kim.

Fig. 2.

After checking the mandible and midline, a surgeon makes a skin incision. The patient provided written informed consent for publication of the research details and clinical images.

Fig. 3.

After the trocar stylet was removed, and the Kelly forceps was inserted through the trocar. The pilot balloon was passed into the trocar lumen, and then the end of the reinforced tube with the connector removed was inserted into the trocar lumen. Illustration by Sujin Kim.

Fig. 4.

A 12-mm trocar is placed from the skin to the mouth floor, and the end of the reinforced endotracheal tube is inserted into the trocar lumen in the mouth. The patient provided written informed consent for publication of the research details and clinical images.

Fig. 5.

A surgeon stabilizes the reinforced endotracheal tube with skin suture. The patient provided written informed consent for publication of the research details and clinical images.

Fig. 6.

After surgery, the reinforced tube is disconnected, and the end of the tube is pulled into the oral cavity. The reinforced tube is reconnected with the ventilator, and the submental incision is sutured. The patient provided written informed consent for publication of the research details and clinical images.