title: Midline submental intubation might be the preferred alternative to oral and nasal intubation in elective oral and craniomaxillofacial surgery when indicated.
abstract: OBJECTIVE
  No consensus exists to date regarding the best method of controlling the airway for oral or craniomaxillofacial surgery when orotracheal and nasotracheal intubations are unsuccessful or contraindicated. The most commonly used method of tracheostomy has been associated with a high degree of morbidity. Therefore, the present study was conducted to determine the indications, safety, efficacy, time required, drawbacks, complications, and costs of the midline submental intubation (SMI) approach in elective oral and craniomaxillofacial surgical procedures.
  
  
  METHODS
  A retrospective case series study was used to evaluate the surgical, financial, and photographic records of all patients who had undergone oral or craniomaxillofacial operations at Sharda University School of Dental Sciences, Greater Noida, from April 2006 to March 2014. The indications, drawbacks, time required for the procedure, ability to provide a secure airway, intra- and postoperative complications, and additional costs associated with SMI were analyzed.
  
  
  RESULTS
  Of the 2,823 patients treated, the present study included 120 patients (97 men and 23 women, aged 19 to 60 years). The average time required for SMI was 10 ± 2 minutes. No episode of intraoperative oxygen desaturation was noted. One intraoperative complication, an injury to the ventral surface of the tongue, was encountered. Two patients developed infection at the skin incision site. No significant additional cost was incurred with the use of SMI.
  
  
  CONCLUSIONS
  SMI has been successfully used in elective oral and craniomaxillofacial surgical procedures for which oral and nasal intubations were either not indicated or not possible. The advantages include a quick procedure, insignificant complications, the ability to provide a stable airway, and no added costs, making SMI a quick, safe, efficient, and cost-effective alternative in such cases.
authors.affiliation: Attending Physician, Department of Stomatology, Yuhuagding Hospital of Yantai, Shandong, China.
authors.forename: Huijun
authors.initials: H
authors.lastname: Jin
authors.affiliation: Associate Professor, Department of Oral and Maxillofacial Surgery, Sharda University School of Dental Sciences, Greater Noida, Uttar Pradesh, India. Electronic address: pavanpatil2000@yahoo.co.uk.
authors.forename: Pavan Manohar
authors.initials: PM
authors.lastname: Patil
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D017558:Elective Surgical Procedures / Q000379:methods; D005147:Facial Bones / Q000293:injuries; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007442:Intubation, Intratracheal / Q000191:economics / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009060:Mouth Floor / Q000601:surgery; D009333:Neck / Q000601:surgery; D061646:Operative Time; D019647:Oral Surgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D012449:Safety; D012887:Skull Fractures / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult