Background and objectives: Airway management in the craniomaxillofacial trauma surgery may require some modifications of the standard intubation techniques. Submental endotracheal intubation may serve as an effective and safe alternative route in these conditions. In standard technique of submentotracheal intubation, the tube is fixed extra orally at the submental incision site with sutures to prevent displacement of the tube during the surgical intervention. But still it leaves a possibility of accidental extubation during the conversion of orotracheal to submental route and vice versa. To counteract this problem we in our institution, fix the tube at two points, one at molar teeth intraorally and second at skin surface externally near submental incision site ensuring a secured airway.
Method used: A total of 10 patients were included with panfacial trauma and were divided into two equal groups of five patients each. Group 1 (test) is intubated using two point fixation technique of submental intubation and Group 2 (control) using standard one point fixation technique. The primary outcome is displacement of tube during orotracheal to submental conversion and vice versa, which was evaluated using fibreoptic endoscope. Secondary outcomes are complications like accidental extubation or endobronchial intubation.
Results: Mean displacement of ET tube in two point fixation group was found to be 3 mm during orotracheal to submental conversion and 2 mm during submental to orotracheal conversion. While in one point fixation group mean displacement of ET tube was found to be 12 mm and 10 mm, respectively. Endobronchal intubation occurred in one patient of group 2.
Conclusion: Two point fixation technique has given better outcomes than standard one point fixation technique. The decrease in tube displacement during submental or orotracheal conversion and vice versa help in avoiding adverse complications like accidental extubation and endobronchal intubation in the patients.
Key words : submentotracheal intubation; fixation techniques; panfacial injuries