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2015 ; 14
(2
): 501-5
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Intubation techniques: preferences of maxillofacial trauma surgeons
#MMPMID26028885
Jaisani MR
; Pradhan L
; Bhattarai B
; Sagtani A
J Maxillofac Oral Surg
2015[Jun]; 14
(2
): 501-5
PMID26028885
show ga
OBJECTIVE: To evaluate the clinical outcomes of alternative techniques of
intubation in patients sustaining maxillofacial injuries, where nasotracheal
intubation (NTI) is best avoided. MATERIAL AND METHODS: Alternative techniques to
standard naso-tracheal intubation like submental intubation, orotracheal
intubation-retrotuberosity/retromolar and missing dentition were used and
variables of clinical outcome recorded. RESULTS: Submental intubation provides an
unobstructed intraoral surgical field, avoids intraoperative and postoperative
complications of tracheostomy, and overcomes the disadvantages of NTI. In our
experience with submental intubation (6 cases), we only had complication related
to tube apparatus like damage to pilot balloon. With retrotuberosity intubation
(5 cases) we did not encounter any complications and the only limitations were
bulbous maxillary tuberosity. Retromolar intubation (4 cases) a safe noninvasive
technique has disadvantages like tube interference within the surgical field and
not feasible in case of limited retromolar space. Orotracheal-missing dentition
intubation (4 cases) is of great advantage i.e. it can be used in cases where NTI
is contraindicated, no specialized skill required, no added cost, avoids the need
for tracheostomy, no extra-oral procedures required and does not interfere with
occlusion/MMF; with disadvantage of occasional tube interference within the
surgical field. CONCLUSION: Preferred techniques of securing an airway like
orotracheal, nasotracheal may not always be applicable, thus a trauma
surgeon-anesthesist team should always have alternative techniques in their
armamentarium to reduce the morbidity associated with these patients without
interference with occlusion, which is prime goal in jaw fracture reduction. We
have used these techniques in a country with limited resources and found them
equally effective and convenient to use.