Articles
- Submental Intubation in Maxillofacial Procedures: A More Desired Approach than Nasotracheal Intubation and Tracheostomy
- Submental Intubation in Oral and Maxillofacial Surgery – A Prospective Clinical Study
Indications
- Contraindications to nasotracheal intubation – epistaxis, CSF fluid leakage, rhinorrhea
- Pan facial trauma
- Basal bone fractures
- Orthognathic surgery + Rhinoplasty
- Craniomaxillary Surgery
Reasons to a Paramedial Incision
- Avoids muscles including the geniohyoid and the genioglossus muscles
- Avoids the insertion of the anterior belly of the digastric muscle
- Avoids caruncle of submandibular glands
Procedure (Paramedial Incision)
* Release the connector of the ETT prior to intubation
- After oral intubations with a cuffed metallic coiled ETT (also known as an anode tube), an incision measuring 2cm is made in the submental and paramedial region, parallel to the lower border of the mandible, and a finger’s breadth from the lower border of the mandible.
- A curved hemostat is passed from the submental incision through the subcutaneous layer, platysma, mylohyoid muscle, submucosal layer, and mucosa. It enters the oral cavity at the junction of the attached lingual alveolar mucosa and the free mucosa of the floor of the mouth.
- An intraoral incision 1 cm in length is made parallel to the gingival soft tissue.
- A large curved hemostat is then placed through th submental incision and the endotracheal tube is exteriorized and connected to the ventilator. The tube is sutures with 1-0 or 2-0 silk sutures.
When doing submental – need armored tube. Make sure the t piece is loose enough to come off. Make incision bigger than you think.
Make incision. Dissect up to lingual of mandible. Poke thru.
Make sure the cuff deflated.
Grab with kelly – one prong for balloon. One prong for et tube.
Pull through.
Make sure not mainstem. Anesthesia to check breath sounds
Suture tube.
