Submental intubation in pediatric maxillofacial surgery: report of 2 cases

Submental intubation (SMI) is useful in surgical procedures where nasotracheal intubation is contraindicated and orotracheal intubation is not ideal, making it an alternative to tracheostomy since it is performed in less time, with less morbidity and mortality, minimal postoperatory care, as well as an aesthetically acceptable scar. We present 2 cases of pediatric patients with a successful SMI. In addition, we briefly review current literature regarding pediatric population.

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

10.37191/mapsci-jdr-1(1)-009 ◽

2021 ◽

Author(s):

Aravindh RJ

Keyword(s):

General Anesthesia ◽

Nasotracheal Intubation ◽

Functional Results ◽

Orotracheal Intubation ◽

Facial Trauma ◽

Minimal Risk ◽

Intermaxillary Fixation ◽

Intubation Technique ◽

Submental Intubation ◽

Intraoperative Period

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.

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Intubação Submentoniana: Quando indicar? – Revisão de literatura

International Journal of Science Dentistry ◽

10.22409/ijosd.v0i55.43117 ◽

2020 ◽

Author(s):

Laryssa Dos Santos Pinheiro

Keyword(s):

Surgical Treatment ◽

Literature Review ◽

General Anesthesia ◽

Surgical Procedures ◽

Orotracheal Intubation ◽

Dental Occlusion ◽

Facial Fractures ◽

Submental Intubation ◽

Elective Tracheostomy ◽

Neurovascular Anatomy

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.

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Cranioplasty for Large-Sized Calvarial Defects in the Pediatric Population: A Review

Craniomaxillofacial Trauma & Reconstruction ◽

10.1055/s-0034-1395880 ◽

2015 ◽

Vol 8 (2) ◽

pp. 159-170 ◽

Cited By ~ 23

Author(s):

Sandi Lam ◽

Justin Kuether ◽

Abigail Fong ◽

Russell Reid

Keyword(s):

Current Literature ◽

Pediatric Patients ◽

Pediatric Population ◽

Calvarial Defects ◽

Dynamic Growth

Large-sized calvarial defects in pediatric patients pose a reconstructive challenge because of children's unique physiology, developing anatomy, and dynamic growth. We review the current literature and outcomes with autologous and alloplastic cranioplasty in the pediatric population.

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Nasotracheal intubation for airway management during anesthesia

Anesthesia and Pain Medicine ◽

10.17085/apm.21040 ◽

2021 ◽

Vol 16 (3) ◽

pp. 232-247

Author(s):

Dong Ho Park ◽

Chia An Lee ◽

Chang Young Jeong ◽

Hong-Seuk Yang

Keyword(s):

Intensive Care ◽

Airway Management ◽

Nasotracheal Intubation ◽

Maxillofacial Surgery ◽

Orotracheal Intubation ◽

Review Article ◽

Oral And Maxillofacial Surgery ◽

Nasal Airways ◽

Surgical Field ◽

Preventive Methods

Nasotracheal intubation is used as a basic method for airway management, along with orotracheal intubation under anesthesia and intensive care. It has become an effective alternative method to orotracheal intubation with increased benefits of offering better mobility and surgical field in oral and maxillofacial surgery and possibly in trauma and critically ill patients. Nasotracheal intubation is performed through a relatively narrow nasal cavity; therefore, additional precautions are needed. Accordingly, nasotracheal intubation methods have evolved over the years with accumulated clinical experience and improved instruments to facilitate safe intubation with reduced complications. Therefore, in this review article, we summarize the basic anatomy of the nasal airways to clarify the precautions, delineate the history and development of various methods and instruments, and describe the indications, contraindications, complications, and preventive methods of nasotracheal intubation.

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A study of submental intubation for anaesthesia in patients with faciomaxillary injuries

International Journal of Clinical Trials ◽

10.18203/2349-3259.ijct20162238 ◽

2016 ◽

Vol 3 (3) ◽

pp. 132 ◽

Cited By ~ 2

Author(s):

Geeta A. Patkar ◽

Nilam Dharma Virkar ◽

Anusha M. S. ◽

Bharati Anil Tendolkar

Keyword(s):

Bone Fractures ◽

Nasotracheal Intubation ◽

Nasal Bone ◽

Orotracheal Intubation ◽

Anesthesia Induction ◽

Management Options ◽

Safe Alternative ◽

Submental Intubation ◽

Careful Handling ◽

Paramedian Incision

Background: Surgical repair of faciomaxillary trauma requires intraoperative occlusion of teeth that precludes orotracheal intubation. Airway management options in these patients are either nasotracheal intubation or tracheostomy. However nasal intubation is contraindicated in nasal bone fractures, skull base fractures. Tracheostomy, being a morbid procedure is not always a good option. Submental intubation allows a safe alternative in such patients.Methods: 25 Patients were studied with faciomaxillary trauma where submental intubation was indicated. After standard anesthesia induction patients were intubated with reinforced endotracheal tube (ETT), which is converted to submental route by a paramedian incision. At the end of the procedure, all patients had inter-maxillary wiring, were shifted to recovery room. Once they are recovered from the neuromuscular blockade ETT was removed through the submental tunnel.Results: This was a prospective observational study in 25 adult patients undergoing faciomaxillary surgeries requiring submental intubation. The mean apnoea time was 1.28±0.38 minutes and induction to submental intubation time was 9.68±1.82 minutes. In one case there was damage to the pilot balloon while pulling the tube through the submental tunnel. Two patients had right endobronchial migration of the ETT. On postoperative follow up, one patient had infection at the submental incision site. Conclusions: Submental intubation is a safe, effective, alternative for short term tracheostomy in faciomaxillary sugeries. Careful handling of the ETT is must to avoid damage while passing through the submental tunnel. Avoid extra length of the tube introrally to prevent endobronchial migration of the ETT.

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Tonsillectomy and Adenoidectomy: Current Techniques and Outcomes

International Journal of Head and Neck Surgery ◽

10.5005/jp-journals-10001-1273 ◽

2016 ◽

Vol 7 (2) ◽

pp. 104-108 ◽

Cited By ~ 2

Author(s):

Steven Andreoli ◽

Gary D Josephson

Keyword(s):

United States ◽

Surgical Technique ◽

Surgical Procedures ◽

Current Literature ◽

Pediatric Population ◽

Normal Activity ◽

The United States ◽

Common Technique ◽

Head Neck

ABSTRACT Tonsillectomy and Adenoidectomy continues to be one of the most commonly performed surgical procedures in the pediatric population with over 500,000 procedures performed annually. Decreasing pain, maintaining hydration, and minimizing the risk of post operative hemorrhage has brought attention to novel surgical technique and instrumentation. Electro-cautery remains the most common technique used across the United States, however newer technologies have evolved claiming improved recovery with expedited return to normal activity and diet. The current literature remains of significant debate as to the modality that offers the best outcomes. In this review, we describe some of the newer technologies and more common modalities used in practice and discuss the current literature findings. How to cite this article Sharma S, Andreoli S, Josephson GD. Tonsillectomy and Adenoidectomy: Current Techniques and Outcomes. Int J Head Neck Surg 2016;7(2):104-108.

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Morbidity and mortality in a national cohort of pediatric patients with hemophagocytic lymphohistiocytosis.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.10062 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 10062-10062

Author(s):

Steven William Allen ◽

Meghan McCormick ◽

Ram Kalpatthi ◽

Louis Rapkin

Keyword(s):

Health Care ◽

Median Time ◽

Hemophagocytic Lymphohistiocytosis ◽

Pediatric Patients ◽

Pediatric Population ◽

Morbidity And Mortality ◽

Cell Transplant ◽

Hematopoietic Stem ◽

Number Of Patients ◽

Initial Hospitalization

10062 Background: Despite significant advances in diagnosing and treating hemophagocytic lymphohistiocytosis (HLH) in the pediatric population, survival remains low and the extent of disease morbidity and health care utilization is poorly characterized. Thus, we sought to investigate morbidity, mortality, and the health care burden of HLH in a pediatric population. Methods: We queried the Pediatric Health Information System (PHIS) for children admitted with HLH and treated with etoposide and dexamethasone between 1/1/2004 – 9/30/2018. Collected data included demographics and clinical variables associated with morbidity and mortality. Results: A total of 493 patients (10.5 per 100,000 patients admitted) met inclusion criteria during the study period. The majority of patients (n = 284, 58%) were less than 5 years of age. A total of 331 patients were readmitted after the initial hospitalization, with 29% of readmissions complicated by infections. Median cost for initial hospitalization was $101,906 (IQR: $47,552 – $271,822). A significant number of patients required ICU care during both the initial admission (60%) and readmission (57%). Hematopoietic stem cell transplant (HSCT) was performed in 136 patients (28%) with a median time to HSCT of 126 days (IQR: 75-193 days). Overall mortality was 32% (n = 158), half occurring during the initial admission. There was a trend towards increased mortality in younger age groups. Median time to death during and after the initial admission was 45 days (IQR: 20-84 days) and 198 days (IQR: 108-368 days), respectively. Post-HSCT mortality rate was 35%. Conclusions: This represents the largest cohort of pediatric patients treated for HLH. Overall and post-HSCT mortality was consistent with prior publications. We observed significant morbidity and increased health care resource utilization in our cohort. These findings emphasize the need for novel therapeutic approaches to improve not only patient survival but also long-term quality of life. Planned future analysis of the PHIS data will be aimed at assessing treatment variability, morbidity and mortality depending on treatment, and risk factors associated with mortality in pediatric patients with HLH.

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Submental tracheal intubation in oromaxillofacial surgery

Indian Journal of Plastic Surgery ◽

10.1055/s-0039-1699221 ◽

2008 ◽

Vol 41 (01) ◽

pp. 15-19

Author(s):

Ramesh Kumar Sharma ◽

Puneet Tuli ◽

Chacko Cyriac ◽

Atul Parashar ◽

Surinder Makkar

Keyword(s):

Skull Base ◽

Surgical Procedures ◽

Skull Base Surgery ◽

Nasotracheal Intubation ◽

Dental Occlusion ◽

Emergency Setting ◽

Le Fort ◽

Oral Intubation ◽

Submental Intubation ◽

Le Fort I

ABSTRACT Background: oromaxillofacial surgical procedures present a unique set of problems both for the surgeon and for the anesthesist. achieving dental occlusion is one of the fundamental aims of most oromaxillofacial procedures. oral intubation precludes this surgical prerequisite of checking dental occlusion. having the tube in the field of surgery is often disturbing for the surgeon too, especially in the patient for whom skull base surgery is planned. nasotracheal intubation is usually contraindicated in the presence of nasal bone fractures seen either in isolation or as a component of le fort fractures. we utilized submental endotracheal intubation in such situations and the experience has been very satisfying.materials and methods: the technique has been used in 20 patients with maxillofacial injuries and those requiring le fort i approach with or without maxillary swing for skull base tumors. initial oral intubation is done with a flexo-metallic tube. a small 1.5 cm incision is given in the submental region and a blunt tunnel is created in the floor of the mouth staying close to the lingual surface of mandible and a small opening is made in the mucosa. the tracheal end of tube is stabilized with magil′s forceps, and the proximal end is brought out through submental incision by using a blunt hemostat taking care not to injure the pilot balloon. at the end of procedure extubation is done through submental location only.results: the technique of submental intubation was used in a series of twenty patients from january 2005 to date. there were fifteen male patients and five female patients with a mean age of twenty seven years (range 10 to 52). seven patients had le fort i osteotomy as part of the approach for skull base surgery. twelve patients had midfacial fractures at the le fort ii level, of which 8 patients in addition had naso-ethomoidal fractures and 10 patients an associated fracture mandible. twelve patients were extubated in the theatre. eight patients had delayed extubation in the post-operative ward between 1 and 3 days postoperatively.conclusion: in conclusion, the submental intubation technique has proved to be a simple solution for many a difficult problem one would encounter during oromaxillofacial surgical procedures. it provides a safe and reliable route for the endotracheal tube during intubation while staying clear of the surgical field and permitting the checking of the dental occlusion, all without causing any significant morbidity for the patient. its usefulness both in the emergency setting and for elective procedures has been proved. the simplicity of the technique with no specialized equipment or technical expertise required makes it especially advantageous. this technique therefore, when used in appropriate cases, allows both the surgeon and the anesthetist deliver a better quality of patient care.

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#52: Clinical Features and Management of Pediatric Patients Presenting with New Onset Acute Leukemia and Concomitant COVID-19

Journal of the Pediatric Infectious Diseases Society ◽

10.1093/jpids/piab031.006 ◽

2021 ◽

Vol 10 (Supplement_2) ◽

pp. S4-S4

Author(s):

Pratik A Patel ◽

Stacey A Lapp ◽

Laila Hussaini ◽

Austin Lu ◽

Evan J Anderson ◽

...

Keyword(s):

Acute Leukemia ◽

Pediatric Patients ◽

Pediatric Population ◽

Lymphoblastic Leukemia ◽

Severe Disease ◽

Population Data ◽

Morbidity And Mortality ◽

Available N ◽

New Diagnosis ◽

New Onset

Abstract Background Infections represent a significant cause of morbidity and mortality in pediatric patients undergoing treatment for hematologic malignancies. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has led to a worldwide pandemic of coronavirus disease 2019 (COVID-19) and pediatric patients with cancer appear to be at higher risk of severe disease than reported in the general pediatric population. Data are limited on the optimal management of children infected with SARS-CoV-2 and a new diagnosis of leukemia. The objective of this study was to describe our experience of six children who presented with a new diagnosis of acute leukemia and concurrent COVID-19. Methods The study was IRB approved and children were enrolled following informed consent and assent as appropriate for age. The clinical presentations, serologic responses, treatments, and outcomes of patients who presented with acute leukemia and concurrent SARS-CoV-2 infection were abstracted. Residual blood was tested by ELISA for quantitative IgG to the SARS-CoV-2 spike protein receptor binding domain (RBD). Results From March 1, 2020 to Dec 31, 2020, 6 patients were identified with a new diagnosis of acute leukemia and SARS-CoV-2 infection including 3 with acute myeloid leukemia (AML) and 3 with acute lymphoblastic leukemia (ALL). The median age of our cohort was 9 years old (range 1 to 19 years old), 5 of 6 were male, and 4 of 6 patients were Hispanic. All 6 patients presented with symptoms that could be attributed to COVID-19 or acute leukemia, with fever being the most common. All 3 of the AML patients presented with hyperleukocytosis (white blood cell count > 50 x 109/L) and required oxygen therapy and intensive care. At the time of presentation, all patients with specimens available (n=5) had IgG antibodies to SARS-CoV-2 RBD. All patients received COVID-19 directed therapy, with remdesivir (n=5) and convalescent plasma (n=5) being the most common. Chemotherapy was modified or delayed in 5 of the 6 patients. The patient who received standard AML chemotherapy without awaiting COVID-19 directed treatment had delayed serologic response, delayed viral clearance from the nasopharynx, protracted respiratory failure, and ultimately died. For patients with a 12-week follow-up (n=5), 2 patients with AML had died, and the ALL patients were in remission and continuing their leukemia treatment. Conclusion COVID-19 may present concurrently in children with new onset leukemia resulting in severe morbidity and mortality. Our experience adds to growing evidence that children with AML and SARS-CoV-2 infection are at risk for severe COVID-19. Screening for SARS-CoV-2 infection with subsequent delay in chemotherapy and administration of COVID-19 directed therapies should be considered for pediatric patients with newly diagnosed acute leukemia and COVID-19.

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Paranasal Mass in a Healthy Male Toddler

Ear Nose & Throat Journal ◽

10.1177/01455613211007944 ◽

2021 ◽

pp. 014556132110079

Author(s):

Melonie Anne Phillips ◽

Meredith Lind ◽

Gerd McGwire ◽

Diana Rodriguez ◽

Suzanna Logan

Keyword(s):

Differential Diagnosis ◽

Pediatric Patients ◽

Pediatric Population ◽

Age Group ◽

Significant Morbidity ◽

Healthy Male ◽

Neck Tumors ◽

Complete Surgical Resection ◽

Maxilla And Mandible ◽

Benign Mass

Head and neck tumors are rare in pediatric patients but should be kept in the differential when a patient presents with a new swelling or mass. One of these tumors is a myxoma, which is an insidiously growing, benign mass originating from the mesenchyme. They most commonly arise in the myocardium but can also develop in facial structures, particularly in the maxilla and mandible. When arising in facial structures, ocular, respiratory, and digestive systems can be affected based on local invasion. Complete surgical resection is curative but can lead to significant morbidity as well. Here, we present a case of a 15-month-old toddler presenting with a paranasal mass, which was ultimately diagnosed as a maxillary myxoma. This tumor is very rare in the pediatric population, especially in the toddler age-group, reminding clinicians to broaden the differential diagnosis when a patient’s course is atypical.

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