Submental Orotracheal Intubation for Maxillofacial Surgery
Notice bibliographique
Résumé
Assistant ProfessorProfessorDepartments of Anesthesia and SurgeryUniversity of ManitobaWinnipeg, Manitoba, Canadaong@cc.umanitoba.caTo the Editor:—Airway management for patients who suffered midfacial fractures is complicated. Tracheostomy and nasotracheal intubation may lead to other complications. 1Nasal intubation can interfere with centralization and stabilization of nasal fractures. An orotracheal tube may compromise the reduction and maintenance of midfacial fractures.We successfully treated a patient with multiple facial fractures using submental intubation. After a motor vehicle accident, a previously healthy 29-yr-old man sustained nasal and bilateral zygomatic fractures, as well as left maxillary fracture with left orbital blowout. There was no evidence of an intracranial or cervical spine injury.After a regular intravenous anesthetic induction, a #7 endotracheal tube was placed orally. Anesthesia was maintained with isoflurane by inhalation and 100% oxygen. The surgeon made a 1-cm incision halfway between the chin and the angle of the mandible. A Kelly forcep was introduced through the skin incision and into the floor of the mouth by blunt dissection. The forcep was kept close to the inner side of the mandible. Care was taken to avoid the submandibular duct and the lingual nerve, which were medial to the proposed tube entry site. A second Kelly forcep was attached to the first Kelly forcep and brought out through the submental incision. A second #7 endotracheal tube was pulled through the submental incision (cuff end first). The initial orotracheal tube was then removed, and the second endotracheal tube was passed into the trachea (fig. 1). The submental intubation procedure took < 10 min to perform. The operative procedure, in which the multiple fractures were reduced and fixated, proceeded uneventfully. Intermaxillary fixation was preformed without any impediment from the submental orotracheal tube. Anesthesia was discontinued, and the patient was extubated in the operating room after he awakened. The submental incision was not closed. His postoperative course was unremarkable. The submental incision healed with minimal scarring.Tracheal intubation via the submental route was first described by Altemir in 1986. 2After orotracheal intubation and establishment of the submental tract, the free end of the endotracheal tube was pulled through a submental incision and reconnected to the anesthetic circuit. There are technical problems with the original technique described. Because of the tight seal of the connector with the reinforced (spiral) endotracheal tube, it is difficult to separate the connector and tube during the transfer from the oropharynx through the submandibular tract. Green and Moore 3reported a modification of Altemir’s approach. The airway was secured with a regular orotracheal tube first. A second endotracheal tube was inserted through the submental route before being exchanged with the previously positioned orotracheal tube. We used the modified technique successfully in our patient with multiple midfacial fractures.The submental orotracheal intubation technique is simple. Further studies with submental orotracheal intubation and tracheostomy are needed to compare the risks and benefits of the techniques.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
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Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,003 | 0,005 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,012 | 0,006 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».