Comparison among the Intubation Techniques Employed in the Course of Management of Pan-Facial Trauma

Objective: To find the best method of intubation in patients sustaining pan-facial trauma by comparing the pros and cons of each technique. Materials and methods: Three different types of intubation techniques (nasotracheal intubation, orotracheal intubation, and sub-mental intubation) were considered in this study. The study population involves 9 patients who have undergone treatment for pan-facial trauma under general anesthesia (3 patients per technique) and the variables of clinical outcome of each group were recorded. Results: Nasal intubation is the most common and safest method of intubation. However, it can’t be used in some types of pan-facial trauma. In cases like these, oral intubation is not preferred. As it severely compromises maxillofacial repair because of interference with the placement of intermaxillary fixation [3](IMF), which is used to establish the patient s occlusion in the intraoperative period. Submental intubation is an alternative with minimal risk to tracheostomy when orotracheal or nasotracheal intubation is not appropriate. The submental intubation technique gave an uninterrupted surgical field, unobstructed airway, ease of gaining occlusion in general anesthesia, less intraoperative and postoperative complications and it overcomes the disadvantages of both nasotracheal and orotracheal intubation. Conclusion: Preferred techniques of securing an airway are orotracheal, nasotracheal intubation. However these techniques may not always be applicable, thus a trauma surgeon-anesthetist team should always have alternative techniques in their armamentarium which secures the patient's airways without interfering with occlusion, to gain at most postoperative esthetic and functional results.

Intubação Submentoniana: Quando indicar? – Revisão de literatura

A intubação submentoniana (ISM), é uma derivação da intubação orotraqueal sem que o tubo passe pela oclusão dentária e lábios do paciente, tendo sua maior indicação a possibilidade da realização da ventilação mecânica do paciente durante um procedimento sob anestesia geral, sem que o tubo atrapalhe as manobras cirúrgicas que exijam um bloqueio maxilo-mandibular transoperatório associado à manipulação da região naso-órbito-etmoidal, evitando assim,a necessidade de uma traqueostomia eletiva. O objetivo deste trabalho é realizar uma revisão de literatura sobre a ISM, abordando suas indicações, contraindicações, vantagens e desvantagens na realização desta técnica. Onde apesar de simples, é fundamental que o profissional tenha o domínio da anatomia óssea e neurovascular da região e do exato posicionamento das glândulas sublinguais, submandibulares e seus ductos, a fim de evitar complicações trans e pós-operatórias imediatas ou tardias. Essa técnica é extremamente bem indicada para facilitar o tratamento cirúrgico de pacientes portadores de múltiplas fraturas da face, reduzindo riscos de complicações graves durante o manejo das vias aéreas pelo médico anestesiologista, sendo de realização rápida, segura e de baixa morbidade.Palavras-chave: intubação submentoniana, intubação endotraqueal, trauma de face.AbstractA submental intubation (ISM) is a derivation of orotracheal intubation without a tube or passes through the patient's dental occlusion and lips, with its greatest indication being the possibility of performing the patient's mechanical technique during the procedure under general anesthesia, without a tube disturbing maneuvers surgical procedures that require a maxillomandibular transoperative block associated with manipulation of the naso-abortion-ethmoidal region, thus avoiding the need for an elective tracheostomy. The objective of this work is to carry out a literature review on ISM, addressing its indications, contraindications, advantages and advantages in carrying out this technique. Where, although simple, it is essential that the professional has mastery of the bone and neurovascular anatomy of the region and the exact level of the sublingual, submandibular glands and their ducts, an end to prevent overflow and immediate or late postoperative. This technique is extremely well indicated to facilitate the surgical treatment of patients with multiple facial fractures, risks of serious complications during the management of the airways by the anesthesiologist, being fast and safe and safe and with low morbidity. Keywords: submental intubation, endotracheal intubation, face trauma.