The presence of significant maxillofacial trauma may make orotracheal or nasotracheal intubation impossible or dangerous. Submental intubation of the trachea may be an alternative to tracheostomy in these patients.
Route:
(1) An incision is made in the submental skin midway between the midline and inferior border of the mandible.
(2) The tubing is passed through the floor of the mouth lateral to the tongue and posterior to the internal aspect of the mandible.
(3) The end of the tube is then passed into the trachea.
Indications for submental intubation - maxillofacial injuries associated with:
(1) nasal bone fractures
(2) fractures of the base of the skull
Indications for submental intubation:
(3) use of temporary intermaxillary fixation for complex maxillofacial injuries AND nasotracheal intubation is not possible
Contraindications for submental intubation (consider tracheostomy instead):
(1) gunshot injuries to the maxillofacial region
(2) tumor ablation in the maxillofacial region
(3) need for long-term airway maintenance
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