title: Can Submandibular Tracheal Intubation Be an Alternative to Tracheotomy During Surgery for Major Maxillofacial Fractures?
abstract: OBJECTIVE
  During surgery for major maxillofacial fractures, orotracheal intubation can interfere with some surgical procedures and nasal intubation can be contraindicated or impossible. That is why tracheotomy is presented as a solution, although it carries a relatively high incidence of complications. In this study, the use of submandibular tracheal intubation is basically evaluated as an alternative to tracheotomy in such circumstances.
  
  
  METHODS
  This prospective study was performed in patients undergoing surgery for major maxillofacial fractures in which oral intubation and/or nasal intubation have been unsuitable, impossible, or contraindicated. The technique of submandibular intubation was assessed intraoperatively and in the postoperative period. The outcomes and complications are presented.
  
  
  RESULTS
  The study included 26 patients aged between 14 and 57 years. All patients had mandibular fractures, with 19 midface fractures (73.1%), 11 nasal bone fractures (42.3%), 10 zygomatic bone fractures (38.5%), 9 naso-orbito-ethmoidal fractures (34.6%), and 9 frontobasilar fractures (34.6%). The procedure time ranged from 5 to 12 minutes (mean, 7 minutes 4.6 seconds). Delayed extubation was performed in 15 cases (57.7%) in which the tube was left in place for a period ranging from 8 to 50 hours (mean, 30 hours 24 minutes). The technique has proved to be straightforward and satisfactory. A postoperative superficial infection occurred in 2 patients, whereas hypertrophic scars occurred in another 2 patients.
  
  
  CONCLUSIONS
  Submandibular endotracheal intubation is straightforward, safe, and quick to carry out. It can be an alternative to tracheotomy as it allows operative techniques and postoperative airway protection without the risks and side effects of tracheotomy.
authors.affiliation: Lecturer of Maxillofacial and Plastic Surgery, Maxillofacial Head and Neck Surgery Unit, General Surgery Department, Faculty of Medicine, Sohag University, Sohag, Egypt. Electronic address: ahmedgaber_74@yahoo.com.
authors.forename: Ahmed Gaber
authors.initials: AG
authors.lastname: Hassanein
authors.affiliation: Lecturer of Anesthesia, Anesthesia Department, Faculty of Medicine, Sohag University, Sohag, Egypt.
authors.forename: Ahmed M A
authors.initials: AM
authors.lastname: Abdel Mabood
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D008297:Male; D008337:Mandibular Fractures / Q000601:surgery*; D008446:Maxillofacial Injuries / Q000601:surgery*; D008875:Middle Aged; D009333:Neck / Q000601:surgery*; D011446:Prospective Studies; D014140:Tracheotomy; D016896:Treatment Outcome