-
8/11/2019 1-s2.0-S0901502711013981-main
1/9
Review Paper
Trauma
Submental intubation:a literature reviewJ.S.Jundt, D.Cattano,
C.A.Hagberg, J.W.Wilson: Submental intubation:a literature review.
Int. J. Oral Maxillofac. Surg. 2012; 41: 4654. # 2011International
Association of Oral and Maxillofacial Surgeons. Published by
ElsevierLtd. All rights reserved.
J. S. Jundt1, D. Cattano2,C. A. Hagberg2, J. W. Wilson3
1Department of Oral and MaxillofacialSurgery, The University of
Texas DentalBranch at Houston, United States;2Department of
Anesthesiology, TheUniversity of Texas Medical School atHouston,
United States; 3Department of Oraland Maxillofacial Surgery, The
University of
Texas Medical School at Houston, UnitedStates
Abstract. A literature review was performed to analyse the
evidence supportingsubmental intubation and to aid in the
development of a new airway algorithm incraniofacial surgery
patients. A systematic search of Pub Med, OVID, the
CochraneDatabase and Google Scholar between January 1984 and April
2011 was performed.Measured variables included the outcome,
complications, publishing specialtyjournal and method of intubation
including technique modifications, indications forthe procedure,
devices utilized and the total procedure time to complete
thesubmental intubation. Of the 842 patient cases from 41 articles
represented in thereview, the success rate was 100%. Minor
complications were reported in 60patients and included superficial
skin infections (N= 23), damage to the tubeapparatus (N= 10),
fistula formation (N= 10), right mainstem bronchus
tubedislodgement/obstruction (N= 5), hypertrophic scarring (N= 3),
accidentalextubation in paediatric patients (N= 2), excessive
bronchial flexion (N= 2),lingual nerve paresthesia (N= 1), venous
bleeding (N= 2), mucocele (N= 1), anddislodgement of the throat
pack sticker in the submental wound (N= 1). Theaverage reported
time to complete a submental intubation was 9.9 min.
Submentalintubation is a safe, effective and time efficient method
for securing an airway whenincreased surgical exposure or
restoration of occlusion is a priority.
Key words: submental intubation; submentalendotracheal
intubation; submental trachealintubation..
Accepted for publication 18 August 2011Available online 17
September 2011
Submental intubation was first reported by
Francisco Hernandez Altemir in 1986 as aprocedure that could
avoid tracheostomyand allow for the concomitant restorationof
occlusion and reduction of facial frac-tures in patients ineligible
for nasotrachealintubation8. This procedure consists
ofexteriorizing an oral endotracheal tubethrough the floor of the
mouth and sub-mental triangle. The original surgical pro-tocol
dictated a 2 cm incision in thesubmental, paramedial region
extendingcephalad until the lingual mucosa wastented with a
hemostat after which another
2 cm incision parallel to the mandible is
made in the lingual gingivae. The breath-ing circuit is briefly
disconnected as thetube is externalized through the submentalregion
and reconnected to the circuit andsecured to the patient. Many
aspects ofsubmental intubation make it a usefulsurgical adjunct in
a variety of settingsincluding facial trauma, pathology andelective
facial surgery. Currently, no sys-tematic literature reviews exist
on thetopic of submental intubation.
In recognition of this deficiency,a systematic literature review
was
performed to analyse the evidence sup-
porting submental intubation. The firstaim of this review is to
summarize theoutcomes, complications, method ofintubation including
technique modifica-tions, indications for the procedure,devices
utilized and the total proceduretime to complete the submental
intuba-tion. A second aim of this review is tointroduce a
maxillofacial trauma airwayalgorithm based on these findings and
todiscuss the benefits of submental intuba-tion over tracheostomy
in select patientpopulations.
Int. J. Oral Maxillofac. Surg. 2012; 41:
4654doi:10.1016/j.ijom.2011.08.002, available online at
http://www.sciencedirect.com
0101-5027/01046+ 09 $36.00/0 # 2011 International Association of
Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All
rights reserved.
http://dx.doi.org/10.1016/j.ijom.2011.08.002http://dx.doi.org/10.1016/j.ijom.2011.08.002http://dx.doi.org/10.1016/j.ijom.2011.08.002http://dx.doi.org/10.1016/j.ijom.2011.08.002
-
8/11/2019 1-s2.0-S0901502711013981-main
2/9
Materials and methods
A systematic search of Pub Med, OVID,Cochrane Database and
Google ScholarBeta between January 1984 and 10 April2011 was
performed. The Pub Medsearch utilized the following NationalLibrary
of Medicine Medical Subject
Headings (MeSH): adult, chin, humans,intubation/methods,
maxillofacial inju-ries/surgery, surgery, and oral/methods.Keywords
searched in other databasesincluded submental intubation,
submen-tal endotracheal intubation, submentalorotracheal intubation
and maxillofacialsurgery, faciomaxillary surgery, andtrauma and
tracheostomy. A preferredreporting items for systematic reviewsand
meta-analyses (PRISMA) flowchartdiagram outlines the number of
articlesidentified, screened, deemed eligible andincluded in this
review (Fig. 1). Exclu-sion criteria included non-English lan-guage
articles, duplicates and articlesthat did not contribute to the
measuredvariables. No blinded randomized
controlled trials have been publishedon submental intubation,
therefore,observer bias must be considered whenreviewing the
evidence.
The level of evidence (LOE) wasranked for each article on a
scale from1 t o 5 (Table 1). Level 1 evidenceincluded well
constructed meta-analyses
of high quality randomized controlledtrials of sufficient size.
Level 2 evidenceincluded lesser quality randomized con-trolled
trials. Level 3 evidence includedcase control studies,
retrospective andprospective analyses. Level 4 evidenceincluded
case series, case reports andsurgical techniques. Level 5
evidenceincluded expert opinion including corre-spondences and
letters to the editor. Theaverage LOE in this report was
3.81comprising the most comprehensiveand best available literature
on submen-tal intubation.
Measured variables in this reviewincluded outcomes,
complications, pub-lishing specialty journal, method of intu-
bation, technique modifications,indications for the procedure,
device uti-lized and the total procedure time to com-plete the
submental intubation.
Results
The search strategies yielded a total of359 abstracts of which
48 remained afterduplicate, non-English and unrelatedcitations were
removed. 48 Full textarticles on submental intubation wereassessed
for inclusion eligibility in thisreview. Published between January
1986and April 2011, these papers included 12retrospective reviews,
two case series,16 case reports, 10 surgical techniques,six
correspondences and two letters tothe editors. Four journal
correspon-dences and three surgical technique arti-cles were
eliminated based on exclusion
criteria
3,5,7,8,18,30,47
. 41 English languagearticles were qualitatively and
quantita-tively assessed in this review and theresults are
presented in Table 2.
Submental intubation: a literature review 47
[
Records identified through databasesearching
(n =354)
Screening
Included
Eligibility
Identification
Additional records identifiedthrough other sources
(n =5)
Records after duplicates/ non-English
removed(n =48)
Records screened
(n =48)
Records excluded
(n =0)
Full-text articles assessedfor eligibility
(n =48)
Full-text articles excluded(n =7)
Studies included in
qualitative synthesis
(n = 41)
Studies included inquantitative synthesis
(n =41)
Fig. 1. Submental intubation PRISMA flow diagram.
-
8/11/2019 1-s2.0-S0901502711013981-main
3/9
Journal publication by specialty
A variety of specialty journals have pub-lished articles on this
technique (Table 3).Anesthesiology journals published 16 arti-cles
on submental intubation representing51 patients. Oral and
maxillofacial surgeryjournals have published 13 articles
repre-senting 648 patients. Craniomaxillofacial,skull base and
trauma surgery journals
have published seven articles representing96 patients. Oral
Medicine/Pathology/Sur-gery journals published two articles
com-prising 15 patients. Three articles havebeen published in
plastic and reconstruc-tive surgery and trauma journals
repre-senting 32 patients. No literature onsubmental intubation was
found in theotorhinolaryngology literature. This defi-ciency in
published reports in the ENTliterature may reflect unfamiliarity
withthe procedure or an inclination towardstracheostomy.
Indications
The most common indication for sub-mental intubation was trauma
(N= 721)in 86% of the reported cases followed byelective facial
osteotomy (N= 100) in12% of
patients1,2,4,6,911,13,15,17,1922,2528,3137,3945,4952,54.
Transmaxil-lary cranial base tumour access(N= 18) comprised 2% of
patients13.
Cancrum oris (N= 1) was the reportedindication in 0.12% of
patients23. Theindication for submental intubation wasnot reported
(N = 2) in two patients14.Whilst nasotracheal intubation is
fre-quently employed in facial trauma andpathology, patients
reported in thisreview were not candidates for this tech-nique due
to perturbed nasal anatomy,nasal-orbital-ethmoidal fractures,
skullbase fractures, cerebrospinal fluidrhinorrhea or extensive
soft tissueswelling29,48.
Original technique and sequential
modifications
The method of intubation was classifiedinto two types for the
purposes of thisreview. The first method referred to hereas the
Altemir sequence involves asingle endotracheal tube that is
exterior-
ized through the submental dissectionplane3. The second method,
referred tohere as the Green and Moore sequenceinvolves two
endotracheal tubeswhereby the first oral tube is replacedby a
second tube introduced throughthe submental tunnel28.
Significantlymore practitioners selected the firstmethod (N= 719)
and fewer utilizedthe Green and Moore sequence(N=
122)21,28,38,45,51,54. One method involved retrograde submental
intuba-tion and utilizeda pharyngeal loop tech-nique (N= 1)10. The
complication rateamongst the Green and Moore sequencewas 21% (N=
26) whereas the compli-cation rate amongst Altemir sequencewas 5%
(N= 34).
Devices utilized in performing the sub-mental intubation
consisted of reinforcedspiral embedded endotracheal tubes(N= 775),
non-reinforced endotrachealtubes (N= 22), reinforced laryngeal
maskairway (LMA) (N= 6), Combitube (N= 1)and not reported (N= 38).
Fibre or metalreinforced tubing is preferred due to theability to
maintain lumen patency at theacute tube angles common in
submentalintubation1,9,1315,19,21,22,2527,31
33,35,36,38,4043,4951,54. No correlationswere found between the
type of tube uti-lized and damage to the tube during
theprocedure.
10 Articles have been publishedoutlining modifications to the
originaltechnique primarily aimed at
reducingcomplications4,6,12,14,28,3537,42,43. Modi-fications were
classified according tointended benefit. Four modificationswere
instituted to reduce the potentialfor intraoperative bleeding
whilstthree modifications aimed at reducingtube damage despite the
relatively
low reported frequency of theseminor complications: 0.24%
and1.19%, respectively4,14,3537,42,43. Table4 details the reported
modifications andintended benefit of each modification.There is
insufficient evidence in theliterature to identify a single
modifica-tion that most reduces the risk ofcomplications associated
with submentalintubation. Additional research is neededto validate
various technique modifica-tions aimed at reducing infrequent
com-plications.
48 Jundt et al.
Table 1. Level of evidence.
Reference Type of study Level of evidence
AGRAWAL & KANG1 Prospective study 3AMIN et al.9
Retrospective study 3BIGLIOLI et al.13 Retrospective study 3CARON
et al.15 Retrospective study 3CAUBI et al.17 Retrospective study
3CHANDU et al.19 Retrospective study 3
DAVIS21 Retrospective study 3GADRE & WAKNIS25 Retrospective
study 3JUNIORet al.31 Retrospective study 3
NAVANEETHAM et al.41 Retrospective study 3SCHUTZ & HAMED49
Retrospective study 3TAGLIALATELA et al.51 Retrospective study
3BABU et al.11 Case report 4DROLET et al.22 Case report 4EIPE et
al.23 Case report 4GORDON & TOLSTUNOV27 Case report 4GREEN
& MOORE28 Case report 4KIM et al.32 Case report 4KIM et al.33
Case report 4LANGFORD34 Case report 4MACINNIS & BAIG36 Case
report 4MAK& OOI38 Case report 4MANGANELLO-SOUZA et al.39 Case
report 4MEYERet al.40 Case report 4UMA et al.52 Case report 4YOON
et al.54 Case report 4CHOI et al.20 Case report 4
NYARADY et al.43 Case report 4GARG et al.26 Case series 4SHARMA
et al.50 Case series 4ALTEMIRet al.5 Surgical technique 4ARYA et
al.10 Surgical technique 4ALTEMIRet al.6 Surgical technique 4LIM et
al.35 Surgical technique 4MAHMOOD & LELLO37 Surgical technique
4
NWOKU et al.42 Surgical technique 4NYARADY et al.44 Surgical
technique 4
AHMED & M ITCHEL2
Correspondence 5BALL et al.12 Correspondence 5BISWAS et al.14
Letter to the editor 5PAETKAU et al.45 Letter to the editor 5
-
8/11/2019 1-s2.0-S0901502711013981-main
4/9
-
8/11/2019 1-s2.0-S0901502711013981-main
5/9
-
8/11/2019 1-s2.0-S0901502711013981-main
6/9
Duration of procedure
19 Articles included the average timerequired to complete the
submentalintubation1,11,13,15,17,20,21,25,26,3133,36,40,41,43,45,50,51.
Procedure time was reportedin 746 patients and averaged 9.9
min.Ranges varied from less than 4 min43
to 30 min20. The two largest retrospec-tive reviews of 107 and
400 patientsindependently averaged 10 min perpatient25,51. By
comparison, a prospec-tive, randomized study comparing
per-cutaneous dilational tracheostomy toopen surgical tracheostomy
reportedaverage time of 20.1 2.0min and41.7 3.9 min,
respectively24.
Complications
Of the 842 patient cases represented in thereview, the success
rate was 100%. Minorcomplications were reported in 60 patientsand
included superficial skin infections(N = 23), damage to the tube
apparatus(N= 10), fistula formation (N= 10), rightmainstem bronchus
tube dislodgement/obstruction (N= 5), hypertrophic scarring(N= 3),
accidental extubation in paedia-tric patients (N = 2), excessive
bronchialflexion (N = 2), transient lingual nerveparesthesia (N=
1), venous bleeding(N= 2), mucocele (N= 1), and dislodge-ment of
the throat pack sticker in thesubmental wound (N=
1)1,9,13,15,17,19,25,
26,34,3941,4951,54. Accidental extubationhas only been reported
in paediatric popu-lations (N= 2). These minor complica-tions are
summarized in Table 5. Nomajor complications associated with
sub-mental intubation have been reported inthe literature. Minor
complicationsoccurred in 7% of patients undergoing
submental intubation.
Discussion
Interest in submental intubation hasslowly risen over thepast 25
years. Almost10 years passed before a second articlewaspublished on
submental intubation in199527. Between 2000 and 2011, 37 of the41
articles included in this review werepublished. Despite this steady
increase inpublications, a relative paucity of litera-ture in
certain surgical specialties where
tracheostomies and facial trauma are com-mon procedures suggests
a lack of aware-ness and potential underutilization.
The indications for submental intuba-tion are specific and as
such lend wellto incorporation in an algorithm. First,
Submental intubation: a literature review 51
Table 3. Number of articles and patients by journal type.
Journal Articles No. of patients
Anaesthesia 16 51Oral and Maxillofacial Surgery 13
648Craniomaxillofacial Surgery 5 47Plastic and Reconstructive
Surgery 3 32Oral Medicine/Pathology/Surgery 2 15Skull Base Surgery
1 24
Trauma/Surgery 1 25
Table 4. Submental intubation modifications.
Author Year Modification Reason for modification
ALTEMIRet al.3 1986 2 cm paramedial incision in a
subperiostealplane. Nasal speculum facilitates tubepassage through
submental region
First report
GREEN & MOORE28 1995 1st tube: oralintubation 2nd tube:
submental
approach. Oral tube is substituted withsubmental endotracheal
tube, patient isreintubated
Allows use of endotracheal tubes with non-
detachable universal connectors
MACINNIS & BAIG36 1999 2 cm midline incision posterior
toWhartons ducts between geniohyoid,genioglossus and anterior belly
of thedigastrics muscles
Decreased bleeding
ALTEMIRet al.5 2000 Utilized a reinforced laryngeal mask
airwayin the submental approach
Allows use in severe laryngotrachealtrauma, singers and patients
with unstablecervical fractures
NWOKU et al.42 2001 2 cm laterosubmental incision Attempts to
avoid significant floor of mouthstructures
MAHMOOD & LELLO37 2002 1 cm midline incision between
Whartonsduct and the reflection of the lingualgingivae and the
floor of the mouth
Decreased bleeding and avoidance ofimportant structures
ALTEMIRet al.6 2003 Utilized a reinforced Combitube in the
submental approach
Assists in tamponade of pharyngeal
haemorrhageBALL et al.12 2003 Flexible tracheal tube with an
intubating
laryngeal maskConnector easily removed and refitted andtube tip
design eases intubation
LIM et al.35 2003 1.5 cm submental and paramedial incision.A
blue cap from a size 32 Fr thoraciccatheter is placed over the
distal end of thetube incorporating the pilot balloon and tube
Reduction of tube damage complications
NYARADY et al.44 2006 A sterile nylon guiding tube is placed
overthe distal end of the tube incorporating the
pilot balloon and tube
Reduction of tube damage complications
BISWAS et al.14 2006 Percutaneous tracheostomy dilatational
kitfacilitates exteriorization of theendotracheal tube through the
submentalroute
Reduction of tube damage complications
-
8/11/2019 1-s2.0-S0901502711013981-main
7/9
submental intubation is indicated inpatients with planned or
traumatic jawfractures necessitating the re-establish-ment of a
functional occlusion in the pre-sence of nasal fractures,
nasal-orbital-ethmoidal fractures, skull base fracturesand
congenital deformities where nasotra-
cheal, oral endotracheal intubation or tra-cheostomy is not
indicated. Second,submental intubation is indicated in caseswhere
increased surgical exposure isdesired such as transmaxillary skull
base
surgeries or complicated infections. Theseindications provide a
useful guide whendetermining airway selection in maxillo-facial
surgery patients. Additional factorsto consider include the length
of antici-pated intubation. Despite several articlesreporting
prolonged submental intubation
of 72 h without adverse effects and noreports to the contrary,
prolonged submen-tal intubation greater than 72 h is notroutinely
practiced due to increased riskof laryngeal damage and
pneumonia27,36.
Commonly, when a submental intubationpatient does not require
long termmechanical ventilation but is not extu-bated
postoperatively, the submental tubeis converted to an oral
endotracheal whichmay remain in place for many days or
evenweeks.
The maxillofacial airway algorithm
begins with the decision to perform acraniofacial surgery. If
ventilator supportis anticipated for a period greater than 7days
and when combined with multipleanticipated surgeries, neurological
defi-cits, compromised pulmonary status orsevere polytrauma a
tracheostomy shouldbe considered. If the anticipated durationof
mechanical ventilation is less than 7days in patients who require
isolated orbi-tal, nasal, zygomaticomaxillary complex,sinus
fractures or soft tissue repair then anoral endotracheal airway
should be con-sidered. This time span reflects the poten-
tial for significant complications asreported in a prospective
study of laryn-gotracheal sequelae associated with intu-bation
longer than 7 days46,53. In thosepatients who sustain jaw fractures
or
52 Jundt et al.
Table 5. Reported complications in submental intubation.
Complication Total % Of patients
Infection 23 2.73Endotracheal tube damage 10 1.19Fistula 10
1.19Right mainstem intubation/obstruction 5 0.59Hypertrophic
scarring 3 0.36Extubation (paediatric) 2 0.24
Venous bleeding 2 0.24Excessive bronchial flexion 2
0.24Transient lingual nerve paresthesia 1 0.12Throat pack sticker
dislodged 1 0.12Mucocele formation 1 0.12
60 7.13
[
Fig. 2. Maxillofacial airway algorithm.
-
8/11/2019 1-s2.0-S0901502711013981-main
8/9
undergo routine orthognathic or tele-gnathic surgery and
anticipated mechan-ical ventilation is less than 7 days,
anasotracheal airway should be considered.Despite 100 reported
cases of submentalintubation in elective facial osteotomypatients,
aesthetic tolerance of scarringis highly variable and in the
authors
opinion limits the usefulness in this patientsubset when
nasotracheal intubation ispossible. In patients with an
anticipatedmechanical ventilation period of less than7 days who
sustain jaw fractures thatrequire the restoration of occlusion
inthe setting of nasal bone, naso-orbital-ethmoidal, skull base
fractures or conge-nital deformity or in head and neck pathol-ogy
or cosmetic cases where enhancedsurgical exposure is necessary,
submentalintubation should be considered. Thisalgorithm is
expressed diagrammaticallyinFig. 2.
In comparing submental intubation andtracheostomy, submental
intubation hasno significant reported major complica-tions.
Tracheostomy complicationsinclude haemorrhage, surgical emphy-sema,
wound site infection, recurrent lar-yngeal nerve injury, tracheal
stenosis,poor scar aesthetics, tracheoarterial fistulaand
death30,46,55. The mortality rate oftracheostomy has been reported
to rangefrom 0.5% to 2.7%16,49,55. In addition tofewer reported
minor complications, sub-mental intubation requires less time than
atracheostomy, costs less and results in an
aesthetically well tolerated scar.In conclusion, submental
intubation isan underutilized, safe and effective tech-nique
forestablishing an airway in patientsrequiring facial
reconstructive surgerywhere traditional methods are
contraindi-cated. Despite the low LOE in the litera-ture, the
cumulative results reported in thismanuscript include the best
available evi-dence. Additional research is necessaryto compare
tracheostomy to submentalintubation and larger studies are
requiredto validate new modifications reportedin the literature.
The potential existsto significantly reduce morbidity by avoid-ing
a tracheostomy in selected patients.Reported complications are
minor andresolve with minimal intervention. Tech-nique
modifications aimed at reducingtube damage may serve to reduce
compli-cations with little added risk. In choosinga potential
modification, the surgeonshould inform the anaesthesiologist
oftheir intended sequence. Communicationbetween the surgeon and
anaesthesiologistis paramount. Innovations based on theoriginal
technique, such as the percuta-neous dilator method described by
Biswas
or enhanced pilot balloon tubing, mayfurther decrease
complications and shouldbe explored in greater detail.
Competing interests
None.
Funding
None.
Ethical approval
Not applicable.
Acknowledgements. The authors wouldlike to thank Anne Starr for
her valuablesecretarial support in the preparation ofthe
manuscript.
References
1. Agrawal M, Kang L. Midline sub-mental
orotracheal intubation in maxillofacial inju-
ries: a substitute to tracheostomy where
postoperative mechanical ventilation is not
required. J Anesthesiol Clin Pharmacol
2011;26:498502.
2. Ahmed FB, Mitchell V. Hazards of submen-
tal tracheal intubation. Anaesthesia 2004;
59:4101.
3. Altemir FH. The submental route for endo-
tracheal intubation. A new technique.J Max-
illofac Surg 1986;14:645.4. Altemir FH. Sub-mental vs.
retromolar intu-
bation. Anaesthesia 2006;61:11234.
5. Altemir FH, Montero SH. The submental
route revisited using the laryngeal mask air-
way: a technical note. J Craniomaxillofac
Surg 2000;28:3434.
6. Altemir FH, Montero SH, Moros Pena M.
Combitube SA through submental route. A
technical innovation. J Craniomaxillofac
Surg 2003;31:2579.
7. Altemir FH, Montero SH, Pena MM. About
submental intubation. Anaesthesia 2003;
58:4967.
8. Altemir FH, Montero SH, Hernandez Mon-
tero S, Hernandez Montero E, Moros PenaM. Hazards of submental
tracheal intubation.
Anaesthesia 2004;59:1140.
9. Amin M, Dill-Russell P, Manisali M, Lee R,
Sinton I. Facial fractures and submental
tracheal intubation. Anaesthesia 2002;57:
11959.
10. Arya VK, Kumar A, Makkar SS, Sharma
RK. Retrograde submental intubation by
pharyngeal loop technique in a patient with
faciomaxillary trauma and restricted mouth
opening. Anesth Analg 2005;100:5347.
11. Babu I, Sagtani A, Jain N, Bawa SN. Sub-
mental tracheal intubation in a case of pan-
facial trauma.Kathmandu Univ Med J2008;
6:1024.
12. Ball DR, Clark M, Jefferson P, Stewart T.
Improved submental intubation.Anaesthesia
2003;58:189.
13. Biglioli F, Mortini P, Goisis M, Bardazzi A,
Boari N. Submental orotracheal intubation:
an alternative to tracheotomy in transfacial
cranial base surgery. Skull Base 2003;13
:18995.
14. Biswas BK, Joshi S, Bhattacharyya P, Gupta
PK, Baniwal S. Percutaneous dilational tra-
cheostomy kit: an aid to submental intuba-
tion. Anesth Analg 2006;103:1055.
15. Caron G, Paquin R, Lessard MR, Trepanier
CA, Landry PE. Submental endotracheal
intubation: an alternative to tracheotomy in
patients with midfacial and panfacial frac-
tures. J Trauma 2000;48:23540.
16. Castling B, Telfer M, Avery BS. Compli-
cations of tracheostomy in major head and
neck cancer surgery: a retrospective study
of 60 consecutive cases. Br J Oral Max-
illofac Surg 1994;32:616.17. Caubi AF, Vasconcelos BC,
Vasconcellos
RJ, de Morais HH, Rocha NS. Submental
intubation in oral maxillofacial surgery:
review of the literature and analysis of 13
cases. Med Oral Patol Oral Cir Bucal
2008;13:E197200.
18. Chandu A, Smith AC, Gebert R. Submental
intubation: an alternative to short-term tra-
cheostomy. Anaesth Intensive Care 2000;
28:1935.
19. Chandu A, Witherow H, Stewart A. Sub-
mental intubation in orthognathic surgery:
initial experience.Br J Oral Maxillofac Surg
2008;46:5613.
20. Choi S, Song SH, Kang NH. Modified sub-mental intubation in
panfacial bone fracture
patients. J Korean Soc Plast Reconstr Surg
2011;38:1279.
21. Davis C. Submental intubation in complex
craniomaxillofacial trauma. ANZ J Surg
2004;74:37981.
22. Drolet P, Girard M, Poirier J, Grenier Y.
Facilitating submental endotracheal intuba-
tion with an endotracheal tube exchanger.
Anesth Analg 2000;90:2223.
23. Eipe N,Neuhoefer ES,La RoseeG, Choudh-
rie R, Samman N, Kreusch T. Submental
intubation for cancrum oris: a case report.
Paediatr Anaesth 2005;15:100912.
24. Freeman BD, Isabella K, Perren CJ, BoyleWA,SchmiegRE,
Kolleff MH, LinN, Saak T,
Thompson EC, Buchman TG. A prospective,
randomized study comparing percutaneous
with surgical tracheostomy in critically ill
patients.Crit Care Med2001;29:92630.
25. Gadre K, Waknis P. Transmylohyoid/sub-
mental intubation: review. Analysis and
refinements. J Craniofac Surg 2010;21:
5169.
26. Garg M, Rastogi B, Jain M, Chauhan H,
Bansal V. Submental intubation in panfacial
injuries: our experience. Dental Traumatol
2010;26:903.
Submental intubation: a literature review 53
-
8/11/2019 1-s2.0-S0901502711013981-main
9/9
27. Gordon NC, Tolstunov L. Submental
approach to oroendotracheal intubation in
patients with midfacial fractures. Oral Surg
Oral Med Oral Pathol Oral Radiol Endod
1995;79:26972.
28. Green JD, Moore UJ. A modification of sub-
mental intubation. Br J Anaesth 1996;77:
78991.
29. Hall DB. Nasotracheal intubation with facialfractures. JAMA
1989;261:1198.
30. Johnson TR. Submental intubation versus
tracheostomy.Br J Anaesth 2002;89:3445.
31. Junior SM, Aspirino L, Moreira RW, Moraes
MD. A retrospective analysis of submental
intubation in maxillofacial trauma patients.J
Oral Maxillofac Surg 2011. [Epub ahead of
print].
32. Kim KF, Doriot R, Morse MA, Al-Attar A,
Dufresne CR. Alternative to tracheostomy:
submental intubation in craniomaxillofacial
trauma.J Craniofac Surg 2005;16:498500.
33. Kim KJ, Lee JS, Kim HJ, Ha JY, Park H, Han
DW. Submental intubation with reinforced
tube for intubating laryngeal mask airway.Yonsei Med
J2005;46:5714.
34. Langford R. Complication of submental
intubation. Anaesth Intensive Care 2009;
37:3256.
35. Lim HK, Kim IK, Han JU, Kim TJ, Lee CS,
Song JH, Yoon SH, Jung JK. Modified sub-
mental orotracheal intubation using the blue
cap on the end of the thoracic catheter.
Yonsei Med J2003;44:91922.
36. MacInnis E, Baig M. A modified submental
approach for oral endotracheal intubation.
Int J Oral Maxillofac Surg1999;28:3446.
37. Mahmood S, Lello GE. Oral endotracheal
intubation: median submental (retrogenial)
approach. J Oral Maxillofac Surg 2002;60:4734.
38. Mak PH, Ooi RG. Submental intubation in a
patient with beta-thalassaemia major under-
going elective maxillary and mandibular
osteotomies. Br J Anaesth 2002;88:28891.
39. Manganello-Souza LC, Tenorio-Cabezas N,
Piccinini Filho L. Submental method for
orotracheal intubation in treating facial
trauma. Sao Paulo Med J1998;116:182932.
40. Meyer C, Valfrey J, Kjartansdottir T, Wilk A,Barriere P.
Indication forand technicalrefine-
ments of submental intubation in oral and
maxillofacial surgery. J Craniomaxillofac
Surg2003;31:3838.
41. Navaneetham A, Thangaswamy VS, Rao N.
Submental inubation: our experience.J Max-
illofac Oral Surg 2010;9:647.
42. Nwoku AL, Al-Balawi SA, Al-Zahrani SA.
A modified method of submental oroendo-
tracheal intubation. Saudi Med J 2002;
23:736.
43. Nyarady Z, Sari F, Olasz L, Nyarady J.
Modified submental endotracheal intubation
in concurrent orthognathic surgery. Mund
Kiefer Gesichtschir2004;8:3879.44. Nyarady Z, Sari F, Olasz L,
Nyarady J. Sub-
mental endotracheal intubation in concurrent
orthognathic surgery: a technical note. J Cra-
niomaxillofac Surg2006;34:3625.
45. Paetkau DJ, Stranc MF, Ong BY. Submental
orotracheal intubation for maxillofacial sur-
gery. Anesthesiology 2000;92:912.
46. Pryor JP, Reilly PM, Shapiro MB. Surgical
airway management in the intensive care
unit. Crit Care Clin 2000;16:47388.
47. Ramsey C, Dhaliwal S. Retrograde and sub-
mental intubation.AtlasOral Maxillofac Surg
Clin North Am2010;18:618.
48. Schultz RC. Nasotracheal intubation in the
presence of facial fractures. Plast ReconstrSurg
1990;86:1046.
49. Schutz P, Hamed HH. Submental intubation
versus tracheostomy in maxillofacial trauma
patients. J Oral Maxillofac Surg 2008;
66:14049.
50. Sharma RK, Tuli P, Cyriac C, Parashar A,
Makkar DS. Submental tracheal intubation
in oromaxillofacial surgery. Indian J Plast
Surg2008;41:159.
51. Taglialatela Scafeti C, Maio G, Aliberti F,Taglialatela
Scafati S, Grimaldi PL. Sub-
mento-submandibular intubation: is the sub-
periosteal passage essential? Experience in
107 consecutive cases.Br J Oral Maxillofac
Surg 2006;44:124.
52. Uma G, Viswanathan PN, Nagaraja PS. Sub-
mandibular approach for tracheal intubation
a case report. Indian J Anaesth 2009;
53:847.
53. Whited R. A prospective study of laryngo-
tracheal sequelae in long-term intubation.
Laryngoscope 1984;94:36777.
54. Yoon KB, Choi BH, Chang HS, Lim HK.
Management of detachment of pilot bal-
loon during intraoral repositioning of thesubmental endotracheal
tube. Yonsei Med J
2004;45:74850.
55. Zeitouni AG, Kost LM. Tracheostomy: a
retrospective review of 281 cases. J Otolar-
yngol1994;23:616.
Address:The University of Texas Dental Branch at
Houston6516 MD Anderson Blvd.
HoustonTX 77030United StatesTel.: +1 713 471 6000
E-mail:[email protected]
54 Jundt et al.
mailto:[email protected]:[email protected]
