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

2016 ◽  
Vol 3 (3) ◽  
pp. 132 ◽  
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

<p class="abstract"><strong><span lang="EN-US">Background: </span></strong>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.</p><p class="abstract"><strong><span lang="EN-US">Methods: </span></strong>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.</p><p class="abstract"><strong><span lang="EN-US">Results: </span></strong>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.  </p><p class="abstract"><strong><span lang="EN-US">Conclusions: </span></strong><span lang="EN-US">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.</span></p>

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

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.

scholarly journals Understanding Nasal Bone Fractures and Its Effects on Management: A Prospective Study

2014 ◽  
Vol 7 (2) ◽  
pp. 58-60
Author(s):  
Nayanjyoti Sarma ◽  
Abhinandan Bhattacharjee
Keyword(s):  
Prospective Study ◽  
Closed Reduction ◽  
Bone Fractures ◽  
Nasal Bone ◽  
Real Patient ◽  
Management Options ◽  
Different Types ◽  
A Prospective Study ◽  
Type Of Fracture

ABSTRACT Objective To evaluate mode of injury and different management options reliant on types of nasal bone fractures. Study design Prospective analytical study. Subjects and methods Seventy-five patients with nasal bone fractured were clinically and radiologically evaluated and divided into different types according to Lee's classification. They were provided conservative, closed reduction and/or osteotomy according to the type of fracture and outcome noted. Results Lee's classification is found to be valid in real patient scenarios and using good radiological evaluation better post operative outcome can be achieved. For type 1 and 3 fractures, closed reduction and osteotomy are the treatment of choice. Conclusion We confirm that systematic approach on Lee's classification for nasal bone fracture can be used to select appropriate management strategy. How to cite this article Sarma N, Bhattacharjee A. Understanding Nasal Bone Fractures and Its Effects on Management: A Prospective Study. Clin Rhinol An Int J 2014;7(2):58-60.

scholarly journals Submental intubation in pediatric maxillofacial surgery: report of 2 cases

1969 ◽  
Vol 48 (2) ◽  
pp. 91-95
Author(s):  
Vanessa Alejandri-Gamboa ◽  
Pedro J. Téllez-Rodríguez ◽  
María C.R. López-Fernández ◽  
Abel Sanjuan-Martínez ◽  
Lina Sarmiento
Keyword(s):  
Surgical Procedures ◽  
Current Literature ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Nasotracheal Intubation ◽  
Maxillofacial Surgery ◽  
Orotracheal Intubation ◽  
Morbidity And Mortality ◽  
Submental Intubation ◽  
Review Current

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.

Sonographic Evaluation of Nasal Bone Fractures

2000 ◽  
Vol 43 (1) ◽  
pp. 95
Author(s):  
Jung Eun Kim ◽  
Sun Wha Lee ◽  
Jung Kyoung Lee ◽  
Sun Hee Chung
Keyword(s):  
Bone Fractures ◽  
Nasal Bone ◽  
Sonographic Evaluation

scholarly journals Patterns of Maxillofacial Fractures in Road Traffic Crashes in an Indian Rural Tertiary Center

2014 ◽  
Vol 3 (2) ◽  
pp. 53-58
Author(s):  
A Sagayaraj ◽  
Rijo M Jayaraju ◽  
Mallika P Reddy ◽  
KR Harshitha ◽  
Priyanka Majety
Keyword(s):  
Road Traffic ◽  
Bone Fractures ◽  
Nasal Bone ◽  
Road Traffic Crash ◽  
Mandibular Fractures ◽  
Traffic Crashes ◽  
Large Variability ◽  
Road Traffic Crashes ◽  
Maxillofacial Fractures ◽  
Tertiary Center

ABSTRACT Background and objectives Road traffic crashes are reported to be the leading cause of maxillofacial fractures in developing countries. The large variability in reported incidence and etiology is due to a variety of contributing factors, including environmental, cultural and socioeconomic factors. The study aims at describing the patterns of maxillofacial fractures in road traffic crashes by clinical and radiological methods and to study the complications associated with these fractures. Materials and methods The study included 100 road traffic crash patients with maxillofacial injuries. Patients were evaluated for any maxillofacial fracture by clinical assessment and, radiologically, using plain radiographs and computed tomography scan. Results Midfacial skeleton was more prone to fractures. Isolated fractures of the maxilla was the commonest (58%) followed by nasal bone fractures (43%). Among the complex fractures, Le Fort type II was the commonest. Mandibular fractures were seen in 33% of the patients, parasymphysis being the commonest site. Majority of the patients had associated soft tissue injuries. The incidence of complications associated with maxillofacial fractures was 11%, malocclusion being the commonest. Conclusion Maxillofacial fractures are commoner in the mobile population in the most productive age group, more so in two wheeler riders causing significant morbidity and mortality. Midface region is more prone to fractures and is most of the time associated with complications. How to cite this article Jayaraju RM, Sagayaraj A, Reddy MP, Harshitha KR, Majety P. Patterns of Maxillofacial Fractures in Road Traffic Crashes in an Indian Rural Tertiary Center. Panam J Trauma Crit Care Emerg Surg 2014;3(2):53-58.

scholarly journals Is Ultrasonography Efficient for the Detection of the Zygomatic Arch, Nasal Bone and Cartilage Fractures?

2020 ◽  
Vol 14 (1) ◽  
pp. 178-183
Author(s):  
Amir Eskandarloo ◽  
Atena karimi ◽  
Abbas Shokri ◽  
Jalal Poorolajal ◽  
Mohammad Hosseinipanah
Keyword(s):  
Bone Fractures ◽  
Imaging Modality ◽  
Nasal Bone ◽  
Kappa Coefficient ◽  
Zygomatic Arch ◽  
Nasal Cartilage ◽  
Specificity And Sensitivity ◽  
Wide Range ◽  
Linear Probe ◽  
And Cartilage

Background: The high incidence of nasal and zygomatic arch fractures highlights the need for an accurate imaging modality for their detection. The superimposition of structures is a major problem in conventional radiography. Ultrasonography is a low-cost imaging modality with a wide range of applications, that does not employ ionizing radiation. This study aimed to assess the efficacy of ultrasonography for the detection of the zygomatic arch and nasal bone fractures. Materials and Methods: This study was conducted on 16 sheep heads. Artificial fractures were created in some parts of the zygomatic arch, dorsum and lateral wall of the nose, and nasal cartilage. All sheep heads underwent Cone-Beam Computed Tomography (CBCT) to ensure the presence of a fracture. Next, the lateral nasal and submentovertex radiographs were obtained, and ultrasonography was performed with a 12-15 MHz linear probe. Ultrasonography and radiography were repeated after 1 week to assess their reproducibility by calculating the kappa coefficient. Data were analyzed using Stata 11 software and Chi-square test. Results: The specificity and sensitivity of ultrasonography ranged from 87% to 100%, and 50% to 75%, respectively. The specificity and sensitivity of radiography ranged from 87% to 100%, and 62% to 87%, respectively. The differences between the two imaging modalities were not statistically significant (p>0.05). The kappa coefficient ranged from 46% to 100% for ultrasonography and 44% to 87% for radiography. Conclusion: Ultrasonography seemed useful for the detection of displaced bone and cartilage fractures. For non-displaced fractures, US is not recommended.

Precut Endotracheal Tubes for Orotracheal Intubation

PEDIATRICS ◽  
1989 ◽  
Vol 83 (5) ◽  
pp. 809-809
Author(s):  
GERALD H. KATZMAN
Keyword(s):  
Nasotracheal Intubation ◽  
Orotracheal Intubation ◽  
Additional Method ◽  
Endotracheal Tubes

Recently, I visited several neonatal units and delivery areas. I noted that the endotracheal tubes used for orotracheal intubation are of a length required for nasotracheal intubation. There is a line on the tube marked with the words "oral" on the side closer to the tip and "nasal" on the farther side. Various techniques have been recommended for managing endotracheal tubes in newborns. The use of endotracheal tubes, precut by the manufacturer for orotracheal intubation, represents an additional method that has several advantages.

scholarly journals Effects of COVID-19 Pandemic on Otolaryngology Surgery in Italy: The Experience of Our University Hospital

2020 ◽  
Vol 163 (1) ◽  
pp. 86-88 ◽  
Author(s):  
Massimo Ralli ◽  
Antonio Minni ◽  
Francesca Candelori ◽  
Fabrizio Cialente ◽  
Antonio Greco ◽  
...  
Keyword(s):  
Head And Neck ◽  
Bone Fractures ◽  
Malignant Tumors ◽  
Nasal Bone ◽  
Upper Airway ◽  
Neck Surgery ◽  
University Hospital ◽  
Outpatient Procedures ◽  
Therapeutic Procedures ◽  
Adults And Children

Otolaryngology and head and neck surgery underwent drastic changes during the COVID-19 pandemic. Since March 10, the first day of the lockdown in Italy, diagnostic and therapeutic procedures were limited to emergency and oncology cases, while outpatient procedures and clinical examinations were temporarily suspended to limit virus diffusion and to reallocate personnel into wards dedicated to COVID-19. In our otolaryngology unit, between March 10 and April 28, 2020, we performed 96 surgical procedures; they mainly consisted in diagnosis and treatment of malignant tumors of the head and neck (77%), management of acute upper airway obstruction in adults and children (14.7%), drainage of abscesses of the head and neck (6.2%), and treatment of nasal bone fractures (2.1%). When comparing these data with those of the same period in 2019 for emergency and oncology procedures, we noticed a drastic reduction of head and neck abscesses and nasal bone fractures, while oncology surgery remained stable.

scholarly journals 19. A Breathing Manikin Model for Teaching Nasotracheal Intubation to EMS Professionals

1996 ◽  
Vol 11 (S2) ◽  
pp. S39-S39
Author(s):  
Juan March ◽  
Kathleen Dunn ◽  
Lawrence Brown ◽  
Johnny Farrow ◽  
Phillip Perkins
Keyword(s):  
Nasotracheal Intubation ◽  
Prospective Trial ◽  
Rapid Sequence Induction ◽  
Training Session ◽  
Orotracheal Intubation ◽  
Rank Test ◽  
Post Intervention ◽  
Convenience Sample ◽  
Before And After ◽  
Signed Rank Test

Purpose: The wide spread use of orotracheal intubation with rapid sequence induction has made it difficult for EMS professionals to gain experience in nasotracheal intubation (NTI) in a controlled supervised setting. The purpose of this study was to determine if a training session on NTI with a breathing manikin can be used to improve skill and comfort of EMS professionals.Methods: A prospective trial was conducted with a convenience sample of 16 emergency medical service professionals, previously trained in nasotracheal intubation techniques. For the training session a Laerdal airway manikin was modified by replacing the lungs with a bag-valve mask device, to simulate breathing with an inspiratory and expiratory phase. Following verbal instruction, and with direct supervision, each participant practiced NTI using the breathing manikin. Each participant completed a questionnaire, both before and after the training session, to determine self assessed comfort and skill level for both oral and nasal intubations (0 = lowest, 10 = highest). The pre and post intervention scores were compared using the Wilcoxon signed-rank test, £ = 0.01.

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