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The submental intubation is retrogrxda procedure that was reported to avoid tracheostomy and allow for the concomitant restoration of occlusion and reduction of facial fractures in patients with craniomaxillofacial trauma, ineligible for nasotracheal intubation due to the potential risk of creating a false passage to the cranial cavity Jundt et al.
There have been several articles in the literature describing and modifying the technique Altemir; Jundt et al.
The limitation of this technique is for patients who also present a neurological deficit or thoracic trauma and need more than 7 days of postoperative ventilator support Jundt et al. A skin incision of 2 cm in the submental, paramedian region and with blunt dissection toward the floor of mouth until the mucosa was tented with a hemostat after which another 2 cm incision is made in the mucosa Fig.
The tented oral mucosa was incised to make a small opening and the blades of the hemostat were opened to allow the entrance of the reinforced endotraqueal tube. Radiologic examination confirmed the presence of Le Fort II fracture, naso-orbitoethmoid fracture, bilateral zygomaticomaxillary complex fractures and left mandible subcondylar fracture. Intracranial malposition of nasopharyngeal airway. Endotracheal tube in position fixed to skin. Further clinical examination did not reveal any other traumatic injury.
The appropriate reinforced endotracheal tube size was passed which connector was previously removed through with the malleable wire as guidance, when the distal end of the endotracheal tube meets the resistance at the level of the cricothyroid membrane against the wirethe wire intubacino cut at the puncture site and the endotracheal tube passed, the remaining wire removed through the tube.
Finally, the endotracheal tube is fixed to skin with sutures to prevent accidental displacement Fig. The original surgical procedure consists in the externalization of the endotracheal tube from the mouth through the floor retroograda the mouth and the submental triangle. Very low rates of complications have been reported.
Extraorally the wound was sutured and the patient was extubated without complications.
After preoxygenation and intravenous induction of anesthesia, submental region and anterior neck is disinfected and draped as usual sterile fashion. The endotracheal tubes now lies on the floor of the mouth between the tongue and the mandible. Submental intubation combines the advantages of nasotracheal intubation, which allows the mobilization of the dental occlusion, and those of orotracheal intubation, which allows access to naso-orbito-ethmoidal fractures Caubi et al.
intubacion retrograda tecnica pdf
Perimortem intracranial orogastric tube in pediatric trauma patient with a basilar skull fracture. Pasaje Republica de Honduras interior The maxillofacial trauma can cause serious disturbances of the soft and hard tissues of the anatomical components of the upper airway and often with little external evidence of deformity Arya et al. The maxillofacial trauma can cause serious disturbances of the soft and hard tissues of the anatomical components of the upper airway and often with little external evidence of deformity.
Many features make the submental intubation very useful in several clinical scenarios including craniomaxillofacial trauma, orthognathic surgery and pathology. Submental intubation versus tracheostomy. In addition, the surgical anatomy of the technique is described in detail.
Guide wire insertion through cricothyroid membrane; B. The management of a intubafion airway is one of the biggest challenges of perioperative anesthesia management. Additional research is necessary to validate new modifications reported in the literature.
The main objective of this study is to describe a modification of the original technique by performing a retrograde submental intubation assisted by direct laryngoscope video in a intbacion trauma patient with restricted mouth opening.
This technique was first described in by Francisco Hernandez Altemir and since its first description 10 articles have been published outlining modifications to the original technique primarily aimed at reducing complications Altemir, ; Jundt et al.
In such cases a tracheostomy is the indicated procedure. In our case where the patient only presented midface isolated trauma with need of intraoperative intermaxillary fixation, submental intubation was the correct choice for intraoperative airway.
INTUBACION RETROGRADA – VIA AEREA DIFICIL ECARRILLO
Many trials have shown the submental route to be a simple, quick and safe approach to airway management Caubi et al. In addition, the surgical anatomy of the technique is detailed described. Submental intubation in oral maxillofacial surgery: University of Puerto Rico. In choosing a potential modification, the surgeon should inform the anesthesiologist of their intended sequence. In a literature review conducted by Jundt et al. The endotracheal tube was disconnected from the breathing circuit and the connector removed the anesthesiologist stabilized at this moment the endotracheal tube with Magill’s forceps to avoid extubation.
However, adequate mouth opening is a prerequisite for the technique. In comparing submental intubation and tracheostomy, submental intubation has no significant reported major complications Jundt et al.
The endotracheal tube was secured and adequate end tidal carbon dioxide curve was observed.
Intubación retrograda modificada
Reinforced endotracheal tube fixed to skin. Each technique has its indications with advantages and disadvantages. Nevertheless, we report for the first time the retrograde submental intubation technique using direct video laryngoscopy. Guide wire red dotted line passed through larynx to oral cavity; B.
Technical Note and Case Report. The submental intubation is a procedure that was reported to avoid tracheostomy and allow for the concomitant restoration of occlusion and reduction of facial fractures in patients with craniomaxillofacial trauma ineligibles for nasotracheal intubation. The open reduction and internal fixation of the facial fractures could then be performed as planned and the occlusion checked with intermaxillary fixation.
In conclusion, submental intubation is a safe and effective technique for establishing a secure airway in patients requiring facial reconstructive surgery where traditional oral and nasotracheal intubation are contraindicated. The Insertion of the wire guide through the cricothyroid membrane helps to place correctly the endotracheal tube and also counting with the assistance of the direct video laryngoscopy, where the complete mouth opening is nitubacion necessary.
The connector and breathing system were reattached and retroograda cuff reinflated.