title: Intubation techniques: preferences of maxillofacial trauma surgeons.
abstract: OBJECTIVE
  To evaluate the clinical outcomes of alternative techniques of intubation in patients sustaining maxillofacial injuries, where nasotracheal intubation (NTI) is best avoided.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Oral and Maxillofacial Surgery, College of Dental Surgery, B.P Koirala Institute of Health Sciences, Dharan, Nepal.
authors.forename: Mehul R
authors.initials: MR
authors.lastname: Jaisani
authors.affiliation: Department of Oral and Maxillofacial Surgery, College of Dental Surgery, B.P Koirala Institute of Health Sciences, Dharan, Nepal.
authors.forename: Leeza
authors.initials: L
authors.lastname: Pradhan
authors.affiliation: Department of Anaesthesiology and Critical Care, B.P Koirala Institute of Health Sciences, Dharan, Nepal.
authors.forename: Balkrishna
authors.initials: B
authors.lastname: Bhattarai
authors.affiliation: Department of Oral and Maxillofacial Surgery, College of Dental Surgery, B.P Koirala Institute of Health Sciences, Dharan, Nepal.
authors.forename: Alok
authors.initials: A
authors.lastname: Sagtani
keywords: Airway; Intubation; Maxillofacial trauma