Endotracheal tube fixation in patients with severe facial burns and edentulism is a challenge. We describe a simple and elegant method to secure the endotracheal tube in such patients by means of an intermaxillary fixation screw.
Facial burns are often accompanied by smoke inhalation, which may eventually lead to upper airway oedema and obstruction. In such cases, prophylactic early endotracheal intubation is indicated as a protective and perhaps life-saving measure. Standard methods to fixate the endotracheal tube, such as adhesive or non-adhesive tape and commercial tube holders, rely on extraoral fixation to the facial skin. Patients with facial burns and blisters present a particular challenge because intact skin is not available ( Fig. 1 a ). The routine in our institution is to secure the endotracheal tube to one of the maxillary teeth using bridle wire around the cervix of the tooth. However, this technique is not possible in the edentulous patient. We describe a simple technique to fixate the endotracheal tube in edentulous patients with facial burns. This work was approved by the ethics committee of the study medical centre.
Local anaesthesia (lidocaine 2% with adrenaline 1:100,000) is infiltrated in the upper vestibule to minimize pain and bleeding during the procedure. An intermaxillary fixation (IMF) screw is inserted in the maxillary bone, preferably in the anterior region in order to avoid critical anatomic structures such as the floor of the nose and the maxillary sinus ( Figs. 1b and 2 ) and to utilize the thick bone of the anterior nasal spine region. Existing imaging, such as computed tomography, can be an adjunct in planning the optimal location for IMF screw insertion. The procedure is completed bedside and does not require cumbersome drilling equipment. Following confirmation of intubation depth, the tube is fixated to the IMF screw using bridle wire that passes through one of the cross-holes of the screw ( Fig. 1 b).