Sub-mental vs. retromolar intubation

Anaesthesia (Impact Factor: 3.85). 12/2006; 61(11):1123-4. DOI: 10.1111/j.1365-2044.2006.04849.x
Source: PubMed
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    ABSTRACT: Maxillofacial trauma, alone or as part of polytrauma, can pose a significant challenge to the anaesthesiologist in the emergency department, in the operating room and in the intensive care unit as it may hamper effective airway management in these patients. Detailed knowledge of maxillofacial and airway anatomy can help in understanding the mechanism, diagnosing the extent and severity of injury and formulating a proper airway management plan. Basic principles of trauma care should be followed at every step. Moreover, the presence of experienced personnel with adequate airway expertise is essential. Anaesthetic drugs and techniques should be optimally tailored to ensure maximal patient safety.
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    ABSTRACT: In craniofacial trauma patients, oral route endotracheal intubation may thwart the accuracy of dental occlusion and nasotracheal intubation carries the risk of intracranial invasion in skull base fracture cases. Between November 2005 and June 2006, patients receiving facial bone fracture operations at Kaohsiung Medical University Hospital were enrolled in this study. Intraoperatively, the endotracheal tube was pushed to either the retromolar space or the missing tooth space and secured by two 4.0 silk stitches. Then, surgeons could perform the usual procedure to explore the fracture sites, check the occlusion and correct the deviated nose without limitation. Also, for better understanding the time needed for various intubation techniques, a time-measuring study was performed. Ninety-one patients were treated by this method. Most of them were satisfied with the result of occlusion and nasal contour. Only 2 patients received second surgery to correct nasal deformity. One hundred seventeen anesthesia procedures were checked. In average, an experienced anesthesiologist could successfully intubate a patient in less than 105 seconds. The advantages and reported complications of different intubation methods were discussed. This retromolar position and tooth fixation technique allowed surgeons to correct the dental occlusion and nasal deformity simultaneously. It has served well for zygoma fracture, maxilla fracture, and Le Fort II fracture patients. It is worthy of consideration in management of middle face trauma patients involving occlusion change and nasal deviation.
    Annals of plastic surgery 07/2009; 63(2):162-6. DOI:10.1097/SAP.0b013e3181855156 · 1.46 Impact Factor